Sertraline induced Leukocytoclastic Vasculitis, a Case Report, and Review Literature (Eng)

Abstract

A rare secondary small vessel vasculitis characterized by inflammation of blood vessels caused by various drugs, including antibiotics, anti-tumor necrosis factor-alpha agents, immunotherapeutic drugs, and psychoactive agents. The skin is most commonly affected, but other tissues and organs, such as the subcutis, kidneys, or lungs, may also be involved. Systemic disease develops only in a minority of patients, typically when treated with the causative drug over a prolonged period of time. Presenting signs and symptoms include skin rash, myalgia, arthralgia, fever, and malaise.¹

Drug-induced vasculitis is a diagnosis of exclusion. There is no laboratory diagnostic tool for drug-induced vasculitis. Eosinophil count may be raised, this is seen more frequently in the case of systemic involvement. A comprehensive drug history of prescribed and over-the-counter medicine is paramount. Tissue biopsy can be beneficial in confirming the diagnosis.¹ The disease entity ranges from relatively benign symptoms requiring supportive care to life-threatening episodes requiring intensive care.The etiologies of vasculitis include autoimmune syndromes, infectious agents, and medications.^2,3.The association of drug therapy with development of cutaneous vasculitis is recognized with numerous therapeutic agents. In fact, it has been estimated that 10–20% of dermal reactions to drugs are vasculitic reactions. Systemic manifestations have been less well reported, even though patients have commonly described nonspecific symptoms such as fever, arthralgia, malaise, and lymphadenopathy.⁴

In the treatment of the major depressive disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder, sertraline is one of the most widely used selective serotonin reuptake inhibitors (SSRIs) and one of the best-tolerated antidepressants.⁵ Here, I present a patient with depressive disorder who developed severe cutaneous vasculitis after using sertraline. For this case study, the patient gave written informed consent.