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Related Experiment Videos

Cutaneous vasculitis secondary to ramipril.

S Gupta1, N M Gandhi, J Ferguson

  • 1Department of Cardiology, Regional Cardiothoracic Centre, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom. sanjaygupta@dr.com

Journal of Drugs in Dermatology : JDD
|February 18, 2004
PubMed
Summary

A rare case of ramipril-induced cutaneous vasculitis occurred in a patient previously tolerating lisinopril. This highlights that prior ACE inhibitor tolerance doesn't prevent future drug-induced vasculitis.

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Area of Science:

  • Dermatology
  • Cardiology
  • Pharmacology

Background:

  • Angiotensin-Converting Enzyme (ACE) inhibitors are commonly prescribed for cardiovascular conditions like left ventricular dysfunction.
  • While ACE inhibitors are known to cause various skin side effects, cutaneous vasculitis is an exceptionally rare adverse event.
  • Previous tolerance to one ACE inhibitor does not preclude the possibility of developing vasculitis from another drug in the same class.

Observation:

  • A 61-year-old patient developed a painful, symmetrical purpuric eruption on both feet within three days of starting ramipril.
  • The patient had a history of successful treatment with lisinopril, another ACE inhibitor, without prior adverse skin reactions.
  • A comprehensive vasculitis workup yielded negative results.

Findings:

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  • The patient's symptoms resolved following the discontinuation of ramipril and a course of corticosteroid therapy.
  • This case represents a rare instance of ramipril-induced cutaneous vasculitis.
  • The atypical presentation, given the patient's prior tolerance to lisinopril, underscores the unpredictable nature of drug-induced vasculitis.

Implications:

  • Clinicians should maintain a high index of suspicion for drug-induced vasculitis, even in patients with a history of tolerating similar medications.
  • Discontinuation of the suspected agent and appropriate treatment, such as corticosteroids, are crucial for managing ramipril-induced cutaneous vasculitis.
  • This case emphasizes the importance of considering cross-reactivity and individual patient responses within the ACE inhibitor class.