背景:IgA血管炎是儿童最常见的系统性血管炎形式,但也可发生在成人中。感染抗原包括感染,毒品,食物,昆虫叮咬,和免疫接种。抗生素和肿瘤坏死因子(TNF)α抑制剂是引起IgA血管炎的最常见药物。虽然索他洛尔和利伐沙班已被证明可引起白细胞碎裂性血管炎,我们从未发现任何文献将IgA血管炎归因于这两种药物.此外,尽管在皮肤和全身血管炎病例中有所描述,但落基山斑疹热与IgA血管炎无关。这里,我们介绍了一例由索他洛尔引发的IgA血管炎,具有挑战性的差异,包括最近感染了落基山斑疹热,恶性肿瘤,利伐沙班是可能的触发因素。
方法:68岁男性,有肺癌病史,5年前接受切除和化疗,目前正在缓解期,最近开始使用索他洛尔和利伐沙班治疗新发阵发性心房颤动。他表现为下肢弥漫性瘀斑/紫癜性皮疹,多发性关节痛,严重的腹痛和直肠出血,咯血,肾功能不全.RMSF的IgG滴度高。皮肤穿刺活检和肾活检符合IgA血管炎。停用索他洛尔和利伐沙班。患者接受口服泼尼松治疗,他的病情相对好转。
结论:IgA血管炎主要是一种自限性疾病,但是成年人往往有严重的病程。早期诊断和识别触发因素非常重要。去除病原体或治疗潜在的感染是管理的一个重要方面。
BACKGROUND: IgA vasculitis is the most common form of systemic vasculitis in children but can occur in adults. Inciting antigens include infections, drugs, foods, insect bites, and immunizations. Antibiotics and tumor necrosis factor (TNF) alpha inhibitors are the most common class of drugs that cause IgA vasculitis. Although sotalol and rivaroxaban have been documented to cause leukocytoclastic vasculitis, we have never come across any literature attributing IgA vasculitis to either drug. Additionally, Rocky Mountain spotted fever has not been associated with IgA vasculitis despite being described in cutaneous and systemic vasculitis cases. Here, we present a
case of IgA vasculitis triggered by sotalol with challenging differentials, including a recent infection with Rocky Mountain spotted fever, malignancy, and rivaroxaban as possible triggers.
METHODS: 68 yr old male with a history of lung cancer treated with resection and chemotherapy 5 years ago is currently in remission, and recently was started on sotalol and rivaroxaban for new-onset paroxysmal atrial fibrillation. He presented with diffuse petechial/purpural rash on the lower limbs, multiple joint pain, severe abdominal pain and rectal bleeds, hemoptysis, and renal dysfunction. IgG titers for
RMSF were high. Punch biopsy of skin and renal biopsy were consistent with IgA vasculitis. Sotalol and rivaroxaban were stopped. The patient was treated with oral prednisone, and his condition relatively improved.
CONCLUSIONS: Ig A vasculitis is mostly a self-limiting disease, but adults tend to have a severe course. It is important to diagnose early and identify a trigger. Removing the offending agent or treating the underlying infection is an important aspect of management.