Anić Branimir, Baresić Marko, Cerovec Mislav, Mayer Miroslav, Bosnić Dubravka, Sentić Mirna, Cikes Nada
Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Kispatićeva 12, Zagreb, Croatia.
Acta Dermatovenerol Croat. 2010;18(2):104-6.
Drug-induced vasculitis is a known side effect of prolonged treatment with several drugs. It is characterized by inflammation and cellular infiltration of small vessels and presence of anti-neutrophil cytoplasmic antibodies (ANCA). Propylthiouracil and hydralazine (anti-thyroid and antihypertensive drugs) are the drugs most commonly associated with drug-induced vasculitis. Small vessels of the skin are most frequently affected, while affection of the vessels of the kidneys, central nervous system and lungs make the diagnosis life-threatening. When drug-induced vasculitis is suspected, quick and punctual diagnostic procedure should be carried out to exclude systemic manifestations. Treatment comprises of elimination of the causative drug, which is sufficient in most cases, but sometimes oral or parenteral glucocorticoids and even immunosuppressants are indicated. A case is presented of an 18-year-old male with a history of Graves disease treated with standard dose of propylthiouracil. Approximately 2.5 years after starting therapy he noticed formation of shallow skin ulcerations on both of his ear lobes and elbows. Detailed hospital work-up found high titers of perinuclear-staining anti-neutrophil cytoplasmic antibodies/myeloperoxidase (pANCA/MPO, 1:1024). Biopsy of the affected skin revealed leukocytoclastic vasculitis. Additional tests excluded systemic vasculitis. The patient was diagnosed with propylthiouracil-induced vasculitis, a form of drug-induced vasculitis. Propylthiouracil was discontinued and the skin lesions disappeared over time without the need of any specific therapy (such as glucocorticoids).
药物性血管炎是几种药物长期治疗已知的副作用。其特征为小血管的炎症和细胞浸润以及抗中性粒细胞胞浆抗体（ANCA）的存在。丙硫氧嘧啶和肼屈嗪（抗甲状腺和抗高血压药物）是与药物性血管炎最常相关的药物。皮肤的小血管最常受累，而肾脏、中枢神经系统和肺部血管受累会使诊断危及生命。当怀疑药物性血管炎时，应进行快速准确的诊断程序以排除全身表现。治疗包括停用致病药物，在大多数情况下这就足够了，但有时需要口服或胃肠外给予糖皮质激素，甚至需要使用免疫抑制剂。本文介绍了一名18岁男性病例，该患者有格雷夫斯病病史，接受标准剂量丙硫氧嘧啶治疗。开始治疗约2.5年后，他注意到双耳耳垂和肘部出现浅表皮肤溃疡。详细的住院检查发现核周染色抗中性粒细胞胞浆抗体/髓过氧化物酶（pANCA/MPO）滴度很高（1:1024）。对受累皮肤进行活检显示白细胞破碎性血管炎。进一步检查排除了系统性血管炎。该患者被诊断为丙硫氧嘧啶诱导的血管炎，这是药物性血管炎的一种形式。停用丙硫氧嘧啶后，皮肤病变随时间消失，无需任何特殊治疗（如糖皮质激素）。
