Kumar Sahil, Narayanan Swetha, Panda Prasan Kumar, Chowdhury Arnab
Department of Medicine (ID Division), All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Curr Drug Saf. 2025;20(3):377-381. doi: 10.2174/0115748863327130240909044620.
It is essential to exclude other causes, such as autoimmune diseases and bacterial infections, before attributing cutaneous/systemic vasculitis to drug use.
This report discusses the case of a young man who developed multi-organ failure and cutaneous vasculitis following the use of antifungal medications (terbinafine and itraconazole) for dermatophyte infections. Tests for autoimmune diseases and infections were negative. Given his drug history and a skin biopsy indicating leukocytoclastic vasculitis, it was inferred that the vasculitis was likely drug-induced. Despite treatment with steroids, intravenous immunoglobulins, and plasmapheresis, the patient did not survive, possibly due to delayed diagnosis and treatment.
In community practice, Drug-induced Vasculitis (DIV) is frequently overlooked. When patients present with skin rash, fever, and multi-organ dysfunction, DIV should be considered, particularly in the context of recent drug use. Over-the-counter antifungals, like terbinafine or itraconazole, can cause DIV and may be fatal if not promptly diagnosed and treated.
在将皮肤/系统性血管炎归因于药物使用之前，排除其他病因（如自身免疫性疾病和细菌感染）至关重要。
本报告讨论了一名年轻男性的病例，该患者在使用抗真菌药物（特比萘芬和伊曲康唑）治疗皮肤癣菌感染后出现多器官功能衰竭和皮肤血管炎。自身免疫性疾病和感染检测均为阴性。鉴于其用药史以及皮肤活检显示白细胞破碎性血管炎，推断血管炎可能是药物引起的。尽管使用了类固醇、静脉注射免疫球蛋白和血浆置换进行治疗，但患者仍未存活，可能是由于诊断和治疗延误。
在社区医疗实践中，药物性血管炎（DIV）常常被忽视。当患者出现皮疹、发热和多器官功能障碍时，应考虑DIV，尤其是在近期用药的情况下。非处方抗真菌药，如特比萘芬或伊曲康唑，可导致DIV，若不及时诊断和治疗可能会致命。
