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Category: Volume 08 Issue 04 April 2020
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Title: Blackening of Distal Fingers and Toes Associated with Pain: A Rare Case of Isoniazide Induced Lupus Cutaneous Vasculitis

Authors: Dr Swapnil Kanire, Dr Ashok Bhupali, Dr Girish H, Dr Shriya G

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.65

Abstract

   

In this article, we present a case of a 27 year old male patient with symptoms and signs suggestive of vasculitis in fingers of upper as well as lower extremities. He was an old case of sputum positive pulmonary tuberculosis for which he received 6 months of antitubercular therapy with isonazide 300mg /day. Prompt diagnosis and treatment in cases of vasculitis is important to prevent irreversible damage to the limb as well as organs. This patient’s all vasculitis workup was negative except ANA homogeneous pattern and antihistone antibody positive  Reported here is a case of isoniazid-induced lupus  presenting with vasculitis. This patient was treated with steroids and cyclophosphamide. He responded well to therapy. The existing literature on the subject is reviewed.

Keywords: Isoniazide, Blood vessel, Drug induced lupus, vasculitis.

References

  1. Sharma P, Sharma S, Baltaro R, Hurley J. Systemic Vasculitis. Am Fam Physician. 2011;83:556-565
  2. Khasnis A, Langford CA. Update on vasculitis. J Allergy ClinImmunol 2009; 123:1226-36
  3. Cutaneous Vasculitis. British Association of Dermatologists. March 2017 http://www.bad.org.uk/shared/get-file.ashx?id=289&itemtype=document
  4. Shakoor N, Michalska M, Harris CA, Block JA. Drug-induced systemic lupus erythematosus associated with etanercept therapy. Lancet 2002; 359:579.
  5. De Rycke L, Kruithof E, Van Damme N, et al. Antinuclear antibodies following infliximab treatment in patients with rheumatoid arthritis or spondylarthropathy. Arthritis Rheum 2003; 48:1015.
  6. Ioannou Y, Isenberg DA. Current evidence for the induction of autoimmune rheumatic manifestations by cytokine therapy. Arthritis Rheum 2000; 43:1431.
  7. Cemil BC, Atas H, Canpolat F, et al. Infliximab-induced discoid lupus erythematosus. Lupus 2013; 22:515.
  8. Yoshimasu T, Hiroi A, Uede K, Furukawa F. Discoid lupus erythematosus (DLE)-like lesion induced by uracil-tegafur (UFT). Eur J Dermatol 2001; 11:54
  9. Vedove CD, Del Giglio M, Schena D, Girolomoni G. Drug-induced lupus erythematosus. Arch Dermatol Res 2009; 301:99.
  10. Sontheimer RD, Gilliam JN. Systemic lupus erythematosus and the skin. In: Systemic Lupus Erythematosus, Lahita RG (Ed), Churchill Livingstone, New York 1992.
  11. McCauliffe DP, Sontheimer RD. Cutaneous Lupus Erythematosus. In: The Clinical Management of Systemic Lupus Erythematosus, Second Edition, Schur PH (Ed), Lippincott, Philadelphia 1996.
  12. Ramos-Casals M, Nardi N, Lagrutta M, et al. Vasculitis in systemic lupus erythematosus: Prevalence and clinical characteristics in 670 patients. Medicine (Baltimore) 2006; 85:95.
  13. Ropes MW. Systemic Lupus Erythematosus, Harvard University Press, Cambridge, MA 1976.
  14. Bateman H, Rehman A, Valeriano-Marcet J. Vasculitis-like Syndromes. Curr Rheumatol Rep 2009; 11:422.
  15. Molloy ES, Langford CA. Vasculitis mimics. Curr Opin Rheumatol 2008; 20:29.
  16. Pretel M, Marquès L, España A. Drug-induced lupus erythematosus. Actas Dermo-Sifiliográficas (English Edition) 2014;105 (1):18–30.
  17. Siddiqui MA, Khan IA. Isoniazid-induced lupus erythematosus presenting with cardiac tamponade. Am J Ther. 2002;9(2):163–65
  18. Merola J. Lupus-Like Syndromes Related to Drugs. In: Schur P, ed. by. Lupus Erythematosus Clinical Evaluation and Treatment. (1st ed) 2012:211–221.

Corresponding Author

Dr Swapnil Kanire

Department of Internal Medicine and Critical Care, Apple Saraswati Multispeciality Hospital and Research Institute Kolhapur, Maharashtra, India