Henoch-Scholein Purpura Related to Fluoxetine Medication in a Child

Abstract

Background: Fluoxetine, one kind of selective serotonin reuptake inhibitors (SSRI), has rarely been reported to be related to vasculitis in adults. Methods: Herein we present a boy who developed Henoch-Schönlein purpura (HSP) during treatment with fluoxetine. Results: This 8-year-old boy suffered from depression about 3 months after he entered a new school. He visited a psychiatric clinic and fluoxetine was prescribed. The response was good and he went back to school smoothly. Sixth weeks later, he developed purpuric rash over bilateral lower extremities which extended to buttock and hands in two days. Mild painful swelling over left ankle was also noted when he was admitted. The investigations were normal including complete blood cell & platelet count, blood biochemistry, liver function tests, prothrombin time, partial thromboplastin time, serum immunoglobulin A and fibrinogen level. Yet D-dimer level was elevated to 8927 μg/dl (normal＜500), consistent with vasculitis. The diagnosis of HSP was made and fluoxetine ceased. Treatment was given with Prednisolone and Ranitidine, after which the purpura resolved in one week. Conclusions: HSP related to fluoxetine medication has rarely been reported in the young adults. Our case may attribute to be the youngest one who receives fluoxetine therapy and give us an example of the potential adverse effect of fluoxetine to the children.

Erythema Multiforme in a Drug-Naive Patient of Obsessive-Compulsive Disorder Initiated on Fluoxetine

“…In another report, a 20-year-old woman initiated on fluoxetine presented with rashes requiring its discontinuation, but a diagnosis of EM was not mentioned 5 . However, other more severe mucocutaneous adverse effects like toxic epidermal necrolysis, 6 Henoch-Schonlein purpura, 7 stomatitis, 8 and bullous pemphigoid 9 have been reported with fluoxetine therapy. On the other hand, EM has been reported with other SSRIs like sertraline 10 and other antidepressants like bupropion, 11,12 trazodone, 13 and mianserin 14 .…”

Henoch–Schonlein purpura due to sodium valproate: A case report

“…The diagnosis of HSP is based on clinical presentations, including the presence of petechial or palpable purport with a special pattern in lower limbs and buttock in addition to one or more of the following signs: abdominal pain, arthritis or arthralgia, and renal involvement 5 . Among the drugs suspected to the development of HSP are antibiotics, 6 anti‐emetics, 7 analgesics, 8 anticoagulants, 9 and anticonvulsant drugs, 10 TNF‐α inhibitors for autoimmune diseases, 11 antihypertensive drugs, 12 antineoplastic, 13 anti‐arrhythmic agents, 14 and antidepressants 15 . However, anticonvulsant drugs are rarely reported with HSP 9 .…”

“… 5 Among the drugs suspected to the development of HSP are antibiotics, 6 anti‐emetics, 7 analgesics, 8 anticoagulants, 9 and anticonvulsant drugs, 10 TNF‐α inhibitors for autoimmune diseases, 11 antihypertensive drugs, 12 antineoplastic, 13 anti‐arrhythmic agents, 14 and antidepressants. 15 However, anticonvulsant drugs are rarely reported with HSP. 9 What we report is possibly the youngest case with HSP that was developed following sodium valproate therapy.…”