Fatal vasculitis associated with ofloxacin.

Abstract

Vasculitis is an adverse effect of numerous drugs. We report on a man who developed vasculitis and died after taking ofloxacin for a chest infection. Case reportA 75 year old man was treated with bumetanide and spironolactone for cardiac failure. Two weeks later he was given ofloxacin 200 mg twice daily for-five days for apparent bronchitis. Several haemorrhagic bullae and palpable purpuric rash developed on the feet and hands (figure). He After the publication of an article entitled "Dermatologists should not be concerned in routine treatment of warts"' we sent a questionnaire to dermatologists to determine whether this was a generally accepted view. We report our results, which show some of the difficulties in defining standards for hospital referrals. Methods and resultsWe sent a questionnaire to 144 randomly selected consultant dermatologists in England and Wales; 131 replies were received (92%). Once general practitioners were sure about the diagnosis ofwarts 46 dermatologists agreed that they should be able to refer any patient they wanted; 43 that they should be able to refer patients with multiple warts; 33 that they should be able to refer patients with single plantar warts; and 93 that they should be able to refer patients with warts resistant to three months' topical treatment. Fifty six, 52, 59, and 17 respectively, however, disagreed that general practitioners should be able to refer under these conditions. Although several dermatologists did not fill in this part of the questionnaire, only three replied "don't know" to these questions. A similar divergence of views was seen in the response to a general question about the appropriateness of a hospital based service for treating warts (table).Widely ranging views were expressed in additional comments or letters, several of which were very detailed. Some consultants argued that warts were far from trivial and that wart clinics offer a valuable 658 BMJ VOLUME 299 9 SEPTEMBER 1989

Detection of specific IgE to quinolones

“…Provocation tests with quinolones might be dangerous because even fatal adverse reactions have been reported. 3,24,[30][31][32] Specific IgE was identified in 30 (54.5%) of 55 patients (IgE-positive group). We did not detect quinolone-specific IgE in 25 patients (IgE-negative group).…”

Cutaneous vasculitis associated with fluoroquinolones

“…Several cases of cutaneous and/or renal vasculitis due to ciprofloxacin, ofloxacin, and levofloxacin drug therapy have been reported [11][12][13][14][15][16][17][18][19][20]. In the published Swiss drug information sheet (Swiss Drug Compendium, Documed, Basel), cutaneous vasculitis is mentioned as adverse events of ciprofloxacin and ofloxacin, but not of levofloxacin.…”

“…Skin lesions may be misinterpreted as a sign of infection. Therefore, each clinician should be aware of quinolone-associated hypersensitivity vasculitis, since any continuation of therapy may be fatal [15].…”

Leukocytoclastic Vasculitis with Systemic Involvement Associated with Ciprofloxacin Therapy: Case Report and Review of the Literature

“…Most patients with this condition have a benevolent course following drug withdrawal, which should usually allow physicians to avoid overtreating these patients. Nevertheless, Pace, et al described a case of fatal vasculitis associated with ofloxacin, and several reports have been made for drug-induced vasculitis with poor outcomes [18, 22]. In view of the knowledge currently available, and considering the age, comorbidities, and systemic involvement which was particular to our patient, pre-emptive glucocorticoid therapy was deemed appropriate for 10 days.…”

“…Even though renal vasculitis with ciprofloxacin-induced LCV is rare, and gastrointestinal involvement has not been documented, drug-induced LCV is known to involve several systems, including the lungs and gastrointestinal tract [17-21]. Pace, et al described systemic vasculitis with cutaneous, gastric, and renal involvement with the use of ofloxacin, another quinolone [22]. Likewise, Ceyhan, et al reported an ofloxacin-induced vasculitis affecting the stomach and colon that presented clinically with bloody diarrhoea [23].…”