Case Report of Sotalol Induced IgA Vasculitis

Abstract

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 recent infection with Rocky Mountain spotted fever, malignancy, and rivaroxaban as possible triggers. Case Presentation: 68 yr old male with history of lung cancer treated with resection and chemotherapy 5 years ago 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 consistent with IgA vasculitis. Sotalol and rivaroxaban was stopped. patient was treated with oral prednisone and improved. Conclusion: Ig A vasculitis is mostly a self-limiting disease, but adults tend to have severe course. It is important to diagnose early and identify a trigger. Removing offending agent or treating underlying infection is an important aspect of management.

Antiarrhythmic Sotalol, Occlusion/Occlusion-like Syndrome in Rats, and Stable Gastric Pentadecapeptide BPC 157 Therapy

“…Sotalol-occlusion/occlusion-like syndrome can be the final endpoint for resolving mentioned discordances in the sotalol and antiarrhythmics effects [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]). Consequently, counteraction by BPC 157 therapy may be important.…”

“…There is a strong anti-arrhythmic effect (i.e., supraventricular arrhythmias, recurrent atrial fibrillation) long ago demonstrated [ 58 ], but also severe prolonged QTc interval prolongation, life-threatening ventricular arrhythmias, including polymorphous ventricular tachycardia or torsade de pointes [ 58 ] (while blood not properly pumped out of the heart, and thereby, pooling and forming a clot [ 8 ]). Long ago, there was a thrombolytic effect of beta blockers and sotalol, in particular [ 59 ], beta-blockers improve endothelial function [ 60 ], but sotalol-induced vasculitis [ 61 ] and diffuse intra-alveolar hemorrhage [ 62 ].…”

Immunglobulin-A Mediated Vasculitis in |A 9 Years-Old Boy

“…Ig-A vasculitis is a childhood disease caused by inflammation of the small blood vessels (vasculitis) [1][2][3][4][5][6][7][8][9][10][11]. It can affect the skin, intestines, kidneys and joints.…”

“…The disease usually resolves within 4 weeks without late health effects. Purpura Schönlein-Henoch is the most common inflammatory vascular disease in young children and school-age children [1][2][3][4][5][6][7][8][9][10][11]. The disease always affects the skin.…”