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Cutaneous vasculitis associated with fluoroquinolones
G Maunz1, T Conzett, W Zimmerli
1Medical University Clinic, Kantonsspital, 4410, Liestal, Switzerland.
Abstract:
Cutaneous vasculitis is a clinical entity with a broad differential diagnosis, including an adverse drug reaction. It is defined as inflammation of skin blood vessel walls. During a 7-year-period, we observed three patients who developed isolated cutaneous vasculitis during antibiotic therapy of bacterial infection. All were treated with a fluoroquinolone (ciprofloxacin or levofloxacin) combined with rifampin (two cases) or flucloxacillin (three cases), respectively. In all three cases the lesions gradually resolved after treatment with the inciting fluoroquinolone had been stopped. In one patient, leukocytoclastic small-vessel vasculitis was histologically confirmed. Fluoroquinolone-associated cutaneous vasculitis consists of an isolated self-limiting disorder that is part of a systemic vasculitis, or even life-threatening disease. Clinicians should be aware of this serious adverse event because any continuation of treatment may be fatal.
Insights
Cutaneous vasculitis can be a serious adverse drug reaction to fluoroquinolone antibiotics. Stopping the antibiotic often resolves the skin inflammation, but clinicians must be vigilant for this potentially fatal condition.
Area of Science:
- Dermatology
- Pharmacology
- Internal Medicine
Background:
- Cutaneous vasculitis involves inflammation of skin blood vessel walls.
- It presents a broad differential diagnosis, including adverse drug reactions.
- Antibiotic therapy is a common cause of drug-induced vasculitis.
Observation:
- Three patients developed isolated cutaneous vasculitis during antibiotic treatment for bacterial infections.
- All patients received fluoroquinolones (ciprofloxacin or levofloxacin) combined with other antibiotics.
- Lesions resolved after discontinuation of the fluoroquinolone antibiotic.
Findings:
- Fluoroquinolone-associated cutaneous vasculitis is a distinct clinical entity.
- It can manifest as an isolated, self-limiting disorder.
- In severe cases, it may be part of a systemic vasculitis or a life-threatening condition.
- Leukocytoclastic small-vessel vasculitis was histologically confirmed in one patient.
Implications:
- Clinicians must consider fluoroquinolone-associated cutaneous vasculitis in patients presenting with skin lesions during antibiotic therapy.
- Prompt recognition and discontinuation of the offending fluoroquinolone are crucial for patient recovery.
- Failure to identify and cease the antibiotic may lead to fatal outcomes.
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