Gavura S R, Nusinowitz S
Department of Pharmacy Services, Mount Sinai Hospital, Toronto, Ontario, Canada.
Ann Pharmacother. 1998 May;32(5):543-5. doi: 10.1345/aph.17286.
To report a possible case of leukocytoclastic vasculitis associated with clarithromycin therapy.
An 83-year-old white woman was prescribed clarithromycin for pneumonia. Six days after her initial presentation, she developed lesions on her palms. Clarithromycin was discontinued at that time. The following day she developed purpuric eccymotic nonblanching lesions that primarily appeared on the lower extremities, buttocks, and abdomen. Colonoscopy revealed generalized erythema and edema of the bowel mucosa. Gastroscopy revealed duodenitis and gastritis, but no bleeding or ulceration. Skin biopsy of the lesions was compatible with leukocytoclastic vasculitis. Renal function was not affected, although hematuria was noted. All symptoms resolved after drug withdrawal and a short course of corticosteroids.
Searches were performed on MEDLINE, Embase, International Pharmaceutical Abstracts, and major adverse drug reaction databases to identify reports and articles discussing clarithromycin- and macrolide-induced leukocytoclastic vasculitis.
Leukocytoclastic vasculitis is one category of drug hypersensitivity reactions characterized by distinctive patterns of perivascular inflammation. The case described here is consistent with the diagnosis of leukocytoclastic vasculitis, and is similar to the other single published case report associated with clarithromycin.
Leukocytoclastic vasculitis induced by clarithromycin is a rare but serious potential adverse effect.
报告1例可能与克拉霉素治疗相关的白细胞破碎性血管炎病例。
一名83岁白人女性因肺炎服用克拉霉素。初次就诊6天后，她手掌出现皮疹。当时停用了克拉霉素。次日，她出现紫癜性瘀斑样非压之褪色皮疹，主要出现在下肢、臀部和腹部。结肠镜检查显示肠黏膜广泛红斑和水肿。胃镜检查显示十二指肠和胃炎，但无出血或溃疡。皮疹皮肤活检结果符合白细胞破碎性血管炎。尽管有血尿，但肾功能未受影响。停药并短期使用糖皮质激素后所有症状均缓解。
检索MEDLINE、Embase、国际药学文摘及主要药品不良反应数据库，以识别讨论克拉霉素和大环内酯类药物引起的白细胞破碎性血管炎的报告和文章。
白细胞破碎性血管炎是一类药物超敏反应，其特征为独特的血管周围炎症模式。此处描述的病例符合白细胞破碎性血管炎的诊断，且与另一例已发表的与克拉霉素相关的病例报告相似。
克拉霉素引起的白细胞破碎性血管炎是一种罕见但严重的潜在不良反应。
