Page 416 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

390 Rami N. Al-Rohil and J. Andew Carlson
Drug-Induced Cutaneous Vasculitis

Hypersensitivity vasculitis due to adverse drug reactions manifests as superficial dermal
neutrophilic or lymphocytic SVV on skin biopsy, and represents about 20% of cases of
cutaneous vasculitis [1, 4, 18, 61]. Tissue eosinophilia is an indicator of drug-induced
cutaneous SVV [62].

Tumor Necrosis Factor-?

Tumor necrosis factor-? (TNF-?) inhibitors employed in the treatment of autoimmune
and rheumatic diseases [63] were the reported cause of cutaneous vasculitis in 8 patients so
treated for 2 to 72 months [64] , including four patients with RA, three patients with
ulcerative colitis, and one patient with Crohn disease. The commonest presenting
manifestation of the patients was palpable purpura, followed by ulcerated lesions,
erythematous macules and blisters. After discontinuation of anti-TNF-?, none had recurrent
vasculitis.

Levamisole

Levamisole was originally introduced as an anthelmintic agent and later employed in
Behçet disease for immunosuppression. More recently Levamisole was added to cocaine to
potentiate the stimulant effects [65].

Figure 20. Levamisole-induced vasculitis shows histologic signs of a vaso-occlusive disorder and
vasculitis.

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