Drug-induced vasculitis: a clinical and pathological review

Direct immunofluorescence (DIF) antibody localization demonstrated negative immunoreactivity for immunoglobulins IgG, IgA, IgM, and complement C3 on sections of frozen skin. UV was suspected, and the diagnosis was confirmed when treatment with 0.6 mg twice daily dosing of colchicine resulted in a good clinical response and subsequent remission of his rash. We described the first case of myxedema coma triggered by IgAvasculitis.

• Combination therapy with both LT4 and LT3 may prove effective, especially for myxedema coma patients with diseases requiring glucocorticoid administration.
• The potential for exacerbation of hypothyroidism in response to a pharmacological dose of glucocorticoid should also be noted.
• Direct immunofluorescence (DIF) antibody localization demonstrated negative immunoreactivity for immunoglobulins IgG, IgA, IgM, and complement C3 on sections of frozen skin.
• Written informed consent was obtained from the patient(s) to publish this paper.

Hypothyroidism in vasculitis

All authors have read and agreed to the published version of the manuscript. Thyroid hormones have a profound impact on the metabolism, growth, development, and differentiation of tissues throughout the body. Moreover, thyroid hormones modulate various aspects of immune function, including immune cell differentiation, proliferation, and cytokine production. They also influence the balance between different types of immune cells, such as T helper 1 (Th1) and T helper 2 (Th2) cells, which play a crucial role in regulating immune responses 7. In conclusion, Henoch–Schönlein purpura (IgA vasculitis) might be occasionally related to thyrotoxicosis and can be intensified by antithyroid agents. A 68-year-old male with a history of hyperlipidemia, sleep apnea, and hypothyroidism secondary to Hashimoto’s thyroiditis presented with a recurring rash over a period of 12 years.

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

The rash consisted of fixed, non-migratory clusters of wheals and pink papules with hyperpigmented macules along the lower back and lower extremities (Figure 1A). Symptom onset typically occurred one month after starting any thyroid replacement medication but would resolve within two months of medication cessation and the addition of systemic corticosteroids. Kidney survival curve of AAV patients with renal injury in different groups. HI, KF, KA, SH, AN, TS, KM, MK, SY, SI, NH, SH, TA, and MN interpreted the data and provided input in the preparation of the manuscript. Figure1 Images of the lower legs, chest X-ray, chest computed tomography, electrocardiogram, and echocardiogram. (C) No abnormalities were found on the electrocardiogram at the time of admission.

3. Relationship between Thyroid Hormone and Clinical Parameters in AAV Patients with Renal Injury

Rapid deterioration of the patient’s condition after admission led to the diagnosis of myxedema coma. LT3 administration should be considered as an alternative treatment for myxedema coma synthroid focus patients requiring concomitant glucocorticoid administration. Beyond this, we cannot ignore the established phenomenon of overlapping syndromes of systemic and organ-specific autoimmune diseases. Among others, Biro et al., in a population of 1517 patients with various autoimmune diseases, found that the prevalence of Hashimoto’s thyroiditis or Grave’s disease was 8.2% 6.

In our study, we were able to review medical records among 52% of case participants, with the history of thyroid disease (or not) and use of specific reported drugs confirmed in 100% of available records. With respect to controls, medical records were not available, but our estimates were similar to well-defined population estimates 7. These statistics give us reasonable confidence that recall was not a major issue in our study. As relevant limitations to our study we must mention the small sample size and retrospective nature. Only this data would, in clinical practice, support the screening of AAbs in UV patients.

Urticarial vasculitis (UV) is identified as a clinicopathologic entity that involves clinical features of urticaria and histopathologic findings compatible with a cutaneous leukocytoclastic vasculitis of small vessels with fibrinoid deposits. UV represents a spectrum of diseases that differ in severity, ranging from an urticaria with minimal vasculitis to a systemic disease that can lead to serious organ-specific complications. Certainly, urticarial vasculitis is an underdiagnosed disease, to the extent that its incidence may vary from 3 to 20% 1. This is due to the lack of a consensus in medical literature upon a disease that manifests diversely, with a definite diagnosis that relies on a high-tech procedure such as biopsy.

• Firstly, it was a single-center study, and the data were collected retrospectively from clinical databases.
• In addition, the thyroid hormone also regulates neutrophil respiratory burst by regulating gp91phox, the catalytic core of NADPH oxidase, which is an important part of the pathogenesis of AAV 8,9.
• Infectious diseases, stroke, myocardial infarction, sedative drugs, and cold exposure are considered the main triggers for myxedema coma.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

The clinical features of AAV were compared between patients with and without hypothyroidism (Table 2). Patients with AAV and hypothyroidism had an increased risk of venous thrombosis. ICO, VLM, GDR formulated the study question, EV, MF wrote the manuscript. And W.Y.; writing—review and editing, S.G.; visualization, Y.W.; supervision, S.G.; project administration, S.G.; funding acquisition, P.F.

• Thus, although the incidence of myxedema coma is low, early diagnosis and avoidance of overlooking this disease are required for successful treatment (2).
• And W.Y.; writing—review and editing, S.G.; visualization, Y.W.; supervision, S.G.; project administration, S.G.; funding acquisition, P.F.
• As relevant limitations to our study we must mention the small sample size and retrospective nature.
• However, she rapidly developed multiple organ failure due to the exacerbation of severe hypothyroidism, i.e., myxedema.
• There might be a possible bias that the included patients might be suspected of having thyroid dysfunction.

1. Patients

She was diagnosed with coexisting immunoglobulin A (IgA) vasculitis and severe IgA vasculitis with nephritis and was consequently treated with intravenous methylprednisolone (125 mg/day). However, she rapidly developed multiple organ failure due to the exacerbation of severe hypothyroidism, i.e., myxedema. Her condition improved significantly following oral administration of prednisolone along with thyroxine. There was a delayed increase in the serum free triiodothyronine level, while the serum free thyroxine level was quickly restored to normal. Rapid deterioration of the patient’s condition after admission led us to diagnose her as having myxedema coma triggered by IgA vasculitis.

In fact, the present patient walked in our hospital, complaining of IgA purpura without myxedema coma; yet, she developed myxedema coma within 6 hours. Therefore, clinicians should be aware of dynamic changes in the condition of patients with hypothyroidism. Disturbed consciousness, severe respiratory failure, and heart failure have been reported as the keys to the diagnosis of myxedema coma (17).