Possible Terbinafine and/or Itraconazole Induced Vasculitis - A Case Study

Area of Science:

• Dermatology
• Pharmacology
• Internal Medicine

Background:

• Cutaneous/systemic vasculitis diagnosis requires excluding autoimmune diseases and infections.
• Drug-induced vasculitis (DIV) is a potential cause of vasculitis.

Observation:

• A young man developed multi-organ failure and cutaneous vasculitis after using terbinafine and itraconazole.
• Autoimmune and infectious disease tests were negative.
• Skin biopsy confirmed leukocytoclastic vasculitis.

Findings:

• The patient's condition was inferred to be drug-induced vasculitis due to antifungal medication use.
• Despite aggressive treatment including steroids, IVIG, and plasmapheresis, the patient did not survive.
• Delayed diagnosis and treatment were potential contributing factors to the fatal outcome.

Implications:

• Drug-induced vasculitis is frequently overlooked in community practice.
• Patients with skin rash, fever, and multi-organ dysfunction, especially with recent drug use, should be evaluated for DIV.
• Over-the-counter antifungals can cause fatal DIV if not diagnosed and treated promptly.