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Published on: February 8, 2019
Cinacalcet-induced leukocytoclastic vasculitis.
George Giannikopoulos1, Markela-Pagonitsa Zorzou, Ioannis Stamoulis
1Department of Internal Medicine, General Hospital of Chios, Chios, Greece.
Summary
Cinacalcet, used to treat secondary hyperparathyroidism in hemodialysis patients, may cause leukocytoclastic vasculitis. This rare adverse drug reaction presents as skin purpura and resolves upon drug discontinuation.
Area of Science:
- Nephrology
- Dermatology
- Pharmacology
Background:
- Secondary hyperparathyroidism is common in patients undergoing maintenance hemodialysis.
- Vitamin D therapy for secondary hyperparathyroidism can lead to severe hypercalcemia.
- Cinacalcet is a calcimimetic agent used to manage secondary hyperparathyroidism.
Observation:
- An 80-year-old woman on hemodialysis developed severe hypercalcemia while on vitamin D therapy.
- Cinacalcet was initiated, and vitamin D dosage was reduced.
- The patient subsequently developed palpable purpura, indicative of leukocytoclastic vasculitis.
Findings:
- Skin biopsy confirmed leukocytoclastic vasculitis.
- The adverse drug reaction was likely caused by cinacalcet, as per the Naranjo scale.
- Symptoms resolved after cinacalcet discontinuation and steroid administration.
Implications:
- Cinacalcet should be considered a potential cause of drug-induced cutaneous leukocytoclastic vasculitis.
- Clinicians should be vigilant for this rare adverse effect in patients treated with cinacalcet.
- Further investigation into the pathogenetic mechanisms of cinacalcet-induced vasculitis is warranted.
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