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Fluticasone-associated cutaneous allergic granulomatous vasculitis
Joseph English1, Kenneth E Greer, Sara A McCrone
1University of Virginia, Department of Dermatology, Charlottesville, Virginia, USA. jce2n@Virginia.edu
Journal of Drugs in Dermatology : JDD
|July 10, 2003
Summary
Churg-Strauss syndrome, a rare vasculitis, can be triggered by inhaled corticosteroids. This case shows a patient developing this condition after using fluticasone and salmeterol, despite no prior asthma history.
Area of Science:
- Immunology
- Pulmonology
- Dermatology
Background:
- Churg-Strauss syndrome (CSS), or allergic granulomatous vasculitis, is a rare small-vessel vasculitis affecting multiple organ systems.
- Recent literature suggests a potential link between CSS development and the use of leukotriene receptor antagonists and inhaled corticosteroids.
- The syndrome typically involves asthma, eosinophilia, and systemic vasculitis.
Observation:
- This report details a patient without a history of allergic asthma.
- The patient acutely developed a skin-limited vasculitis resembling CSS.
- This condition emerged shortly after initiating therapy with inhaled fluticasone and salmeterol (Advair Diskus).
Findings:
- The patient presented with skin-limited granulomatous vasculitis.
- The onset of vasculitis was temporally associated with the use of inhaled fluticasone and salmeterol.
- This case suggests a potential association between inhaled corticosteroid use and CSS-like vasculitis, even in the absence of asthma.
Implications:
- Inhaled corticosteroids, commonly used for respiratory conditions, may unmask or induce CSS-like vasculitis.
- Clinicians should consider CSS in patients presenting with vasculitis, particularly those on inhaled corticosteroid therapy, even without a prior asthma diagnosis.
- Further research is warranted to elucidate the mechanisms linking inhaled corticosteroids to CSS and to define risk factors.