Antibiotic-induced IgA vasculitis: insights from a real-world retrospective analysis and pharmacovigilance assessment

IgA vasculitis (IgAV) is a small-vessel vasculitis characterized by the deposition of immunoglobulin A (IgA) in the vessel walls, often presenting with cutaneous manifestations such as palpable purpura. Drug-induced IgAV is a rare but potentially severe condition. Several studies have suggested a possible association between antibiotics and IgAV. However, research on this link remains limited. This study aimed to identify antibiotics implicated in the onset of IgAV and to analyze the clinical characteristics of IgAV induced by antibiotics. Data on antibiotic-induced IgAV events were extracted from the FDA Adverse Event Reporting System (FAERS) database, and case reports were collected through literature searches. A pharmacovigilance analysis was conducted using FAERS data from 2003 to 2023 to evaluate adverse events related to IgAV caused by antibiotics, and case reports up to November 23, 2024, were reviewed for retrospective analysis. A total of 150 reports of antibiotic-induced IgAV were analyzed, with 13 antibiotics identified as associated with IgAV. The three antibiotics most strongly linked to IgAV were ofloxacin, vancomycin, and clarithromycin based on the FAERS database analysis. The median age of the cases was 58 years, with a male predominance. IgAV typically developed 4 days (1-15 days) after drug administration. Clarithromycin, vancomycin, and ciprofloxacin were the most frequently reported antibiotics in the literature, and they were also associated with poor renal outcomes, emphasizing the importance of regular follow-up to improve long-term renal prognosis. In conclusion, this study identified 13 antibiotics associated with IgAV, with ofloxacin, vancomycin, and clarithromycin being the most strongly linked to the condition.