Nonthrombocytopenic purpura associated sequentially with nifedipine and diltiazem

To report the case of a patient who developed nonthrombocytopenic purpura sequentially following the administration of nifedipine and diltiazem.

Case reports, MEDLINE review of pertinent literature, and review of relevant studies.

Data were extracted from direct patient observation and review of laboratory studies and published reports.

Nonthrombocytopenic purpura secondary to cutaneous vasculitis is a known, although rare, adverse effect of nifedipine. It has not been reported in association with diltiazem. We report the case of a 75-year-old woman in whom a purpuric rash demonstrated by biopsy to be attributable to cutaneous vasculitis developed in the course of nifedipine therapy. The rash disappeared after discontinuation of the drug; however, it recurred when diltiazem therapy was initiated.

Nonthrombocytopenic purpura may be associated with diltiazem as well as with nifedipine. When this adverse effect occurs following administration of a calcium-channel blocker, caution is advised in using other agents of the same class.