Dronedarone is an antiarrhythmic drug approved by the FDA in 2009.Smallvessel vasculitis has not been previously reported in association with dronedarone.
71 year old male was admitted with 1 week history of generalized skin rash, decreased appetite and lower abdominal and back pain. Other medical history included Paroxysmal Atrial Fibrillation and StevensJohnson syndrome with bactrim in 2007.Serum creatinine was 1.4 on admission that trended high to a maximum of 1.7 in the next week and then fell back to normal. pANCA, cANCA, mitochondrial and smooth muscle antibodies were negative. Complement levels were found to be normal. All other labs were unremarkable. Skin biopsies were performed, and histopathological studies of the biopsy specimens showed predominant perivascular infiltrates composed of lymphocytes (Fig 2) and neutrophils with prominent extravasation of erythrocytes (Fig 2) within the stroma, consistent with leukocytoclastic vasculitis. Kidney biopsy revealed mesangial immune deposits on electron microscopy with dominant IgA on immunofluorescence study. Colonoscopy with rectal biopsy showed colonic mucosa with focal ulceration, granulation tissue formation.Four weeks previously his cardiologist started him on Dronedarone for Atrial Fibrillation. Two weeks later the patient developed rash on both his legs associated with fever and shortness of breath. Patient was given levofloxacin for these symptoms by the primary care physician, but there was no improvement. The patient stopped taking all his medications two days prior to admission. In the hospital patient developed rectal bleed. Physical examination revealed normal body temperature, clear lungs, irregularly irregular heart rate and mild lower abdominal tenderness. No hepatosplenomegaly or lymphadenopathy was present. Skin examination revealed erythematous, maculopapular rash, 110mm in diameter over thighs (Fig1), Calves, hands, abdomen and chest. Hemorrhagic, bullous lesions were found in the axillae and on both legs above the ankles, with no signs of secondary bacterial infections.
Treatment with steroids was initiated and dronedarone was not restarted. Within a few days the lesions and symptoms completely resolved. The patient had no further episodes of skin rash over a follow up period of six months.
HenochSchönlein purpura is a smallvessel vasculitis that primarily affects children and is characterized by vascular and/or mesangial immunoglobulin A deposition. In the absence of any other known cause, the development of HenochSchonlein Purpura after initiation of Dronedarone and its rapid reversal on withdrawal could be attributed to this drug. Using Naranjo ADR probability scale dronedarone seems to be the probable etiology. With the understanding that systemic vasculitides could be life threatening, physicians should be aware of this possible adverse reaction in order to intervene promptly and avoid serious complications.
Figure 1Palpable purupuric rash.
Figure 2Lymphocytic infltration & erythrocyte extravasation.
To cite this abstract:AlBataineh M, Fernandes N. Dronedaroneinduced Henochschonlein Purpura. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97666. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/dronedaroneinduced-henochschonlein-purpura/. Accessed March 28, 2020.