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M. Brouard, V. Piguet, P. Chavaz, L. Borradori, Schönlein–Henoch purpura associated with losartan treatment and presence of antineutrophil cytoplasmic antibodies of x specificity, British Journal of Dermatology, Volume 145, Issue 2, 1 August 2001, Pages 362–363, https://doi.org/10.1046/j.1365-2133.2001.04361.x
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Sir, Schönlein–Henoch purpura (SHP) is a systemic small‐vessel vasculitis characterized by vascular deposition of IgA‐dominant immune complexes.1 Although this syndrome characteristically follows an upper respiratory tract infection, drugs have also been implicated as a cause.2 We report a case of SHP that developed after introduction of losartan, a novel angiotensin II receptor antagonist,3 and was unusual for its association with antineutrophil cytoplasmic antibodies (ANCA) of x specificity (xANCA).
A 79‐year‐old caucasian woman was admitted for evaluation of fatigue, arthralgias of the ankles and wrists, and cutaneous purpuric lesions. She also had a chronic obstructive pulmonary disease and cardiac insufficiency with chronic atrial fibrillation, treated with digoxin, acetylsalicylic acid and zolpidem for the previous year. Because of arterial hypertension she was given losartan 4 weeks prior to the development of the symptoms. In addition, she had recently been given mianserin for depression. On examination, she had oedema of the legs and many infiltrated purpuric lesions of up to 2 cm in diameter, located on the lower extremities, ankles, thighs, buttocks and arms. The lesions were in part necrotic with haemorrhagic blisters.
