A Case of Montelukast-Induced Churg-Strauss Syndrome Associated with Liver Dysfunction

Matsumoto, Keiji; Nishijima, Kosuke

doi:10.1155/2011/412524

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…In individuals suffering from asthma, LTRA-induced CSS commonly presents with a wide range of clinical signs, including fever, malaise, arthralgias, clinical jaundice, peripheral blood eosinophilia, eosinophilic hepatitis, scleritis and arthritis [19,20,21,22,23,24,25,26,27,28,29,30]. Pulmonary involvement can be prominent, and chest radiography can show mixed alveolar-interstitial eosinophilic (80%) infiltrates in the upper lobes [31].…”

Section: Immune System Disordersmentioning

confidence: 99%

Montelukast-Induced Adverse Drug Reactions: A Review of Case Reports in the Literature

Calapai¹,

Casciaro²,

Miroddi³

et al. 2014

Pharmacology

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Background: Montelukast, a leucotriene receptor antagonist, binds the cysteinyl leucotriene type 1 receptor. Montelukast is commonly prescribed to asthma patients as add-on therapy to inhaled corticosteroids. Several clinical trials emphasized that montelukast can be considered a safe drug. However, recent evidence reconsidered the benefit/risk ratio of the use of montelukast for both paediatric and adult patients. Summary: The present review analyzed the previous published case reports regarding montelukast-induced adverse drug reactions (ADRs). They included agitation, anxiety, depression, sleep disturbance, hallucinations, suicidal thinking and suicidality, tremor, dizziness, drowsiness, neuropathies and seizures. The immune system can be involved, in particular, cases of Churg-Strauss syndrome have been published. Furthermore, it can induce hypersensitivity reactions, including anaphylaxis and eosinophilic infiltration. In addition, hepatobiliary, pancreatic and uropoietic disorders have been observed. Some of these cases are characterized by severe prognosis (i.e. neurological deficit and fatal hepatotoxicity). Key Message: The use of montelukast can be burdened by several ADRs, of which physicians should be aware in their clinical practice. A better understanding of the mechanisms causing ADRs after using montelukast could help researchers and clinicians in defining a risk-reduction strategy aimed to lessen montelukast toxicity. More accurate epidemiological studies, in order to discover risk factors favouring montelukast-associated ADRs, are demanded.

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Section: Immune System Disordersmentioning

confidence: 99%

Montelukast-Induced Adverse Drug Reactions: A Review of Case Reports in the Literature

Calapai¹,

Casciaro²,

Miroddi³

et al. 2014

Pharmacology

View full text Add to dashboard Cite

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Eosinophilic granulomatosis with polyangiitis and its association with montelukast: a case-based review

Alexander,

Moore,

Lenert

2024

Clin Rheumatol

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Refractory drug-induced systemic small-vessel vasculitis with two varied extracutaneous manifestations: a case report and review of the literature

Jovanovic,

Sabovic

2023

J Med Case Reports

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Background Clopidogrel and ticagrelor are rarely reported to cause vasculitis via drug hypersensitivity reaction, largely mediated by T cells and immunoglobulin E (IgE). Despite therapeutic advances, the etiology of refractory vasculitides remains incompletely understood. Recently, (non)immunological mechanisms bypassing T cells and IgE have been proposed to explain resistance to standard immunosuppressants. Herein, we report a case of refractory drug-induced systemic small-vessel vasculitis with varied extracutaneous manifestations and incorporate multiple sources of data to provide detailed accounts of complex (non)immunological phenomena involved in this case. Study objectives are to provide an insight about rare presentations of commonly used drugs, upgrade the pathophysiological concepts of drug-induced vasculitis, raise need for further investigation to define causes and risk factors for refractory vasculitis, and discuss most of the current knowledge suggesting novel therapeutic approaches to treat this vasculitis. To our knowledge, this is the first case of the two flares of systemic small-vessel vasculitis in a single patient in response to clopidogrel and ticagrelor exposure, respectively. However, this report is limited by attribution/observer bias. Case presentation We herein report a 24-year-old Caucasian male student with a medical history of mild seasonal allergic rhinoconjunctivitis, tension-type headaches, posttraumatic arterial stenosis, and previous exposure to ibuprofen, acetylsalicylic acid, and mRNA coronavirus disease 2019 (COVID-19) vaccine who suffered largely from acute urticaria and dyspnea after 20 days of acetylsalicylic acid and clopidogrel introduction. A skin punch biopsy confirmed leukocytoclastic vasculitis. Serologic antibody testing, complement analysis, microbiologic testing, and cancer biomarkers revealed no abnormalities. Regarding the patient’s medical history, both acetylsalicylic acid and clopidogrel were exchanged for ticagrelor. Furthermore, the addition of naproxen, cyclosporine, bilastine, prednisolone, and montelukast resulted in complete recovery. After 7 days, diarrhea and hematuria occurred. Urinalysis and computed tomography showed reversible proteinuria with gross hematuria and hypodense changes in kidney medulla, respectively, associated with discontinuation of ticagrelor and naproxen. In addition, the patient recovered completely without any immunosuppression up-titration. Conclusions This case highlights the role of clopidogrel and ticagrelor as possible triggering agents for systemic small-vessel vasculitis and offers an insight into novel therapeutic strategies for refractory vasculitides. Further research is needed to build on the findings of a current report.

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A Case of Montelukast-Induced Churg-Strauss Syndrome Associated with Liver Dysfunction

Cited by 3 publications

References 14 publications

Montelukast-Induced Adverse Drug Reactions: A Review of Case Reports in the Literature

Montelukast-Induced Adverse Drug Reactions: A Review of Case Reports in the Literature

Eosinophilic granulomatosis with polyangiitis and its association with montelukast: a case-based review

Refractory drug-induced systemic small-vessel vasculitis with two varied extracutaneous manifestations: a case report and review of the literature

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