Possible Terbinafine and/or Itraconazole Induced Vasculitis - A Case Study

• Published in: Current drug safety
• Main Authors: Kumar, Sahil, Narayanan, Swetha, Panda, Prasan Kumar, Chowdhury, Arnab
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 19.09.2024
• Subjects: leukocytoclastic vasculitis; Adverse drug reaction; antifungals; cutaneous vasculitis
• ISSN: 2212-3911
• DOI: 10.2174/0115748863327130240909044620

It is essential to exclude other causes, such as autoimmune diseases and bacterial infections, before attributing cutaneous/systemic vasculitis to drug use. This report discusses the case of a young man who developed multi-organ failure and cutaneous vasculitis following the use of antifungal medications (terbinafine and itraconazole) for dermatophyte infections. Tests for autoimmune diseases and infections were negative. Given his drug history and a skin biopsy indicating leukocytoclastic vasculitis, it was inferred that the vasculitis was likely drug-induced. Despite treatment with steroids, intravenous immunoglobulins, and plasmapheresis, the patient did not survive, possibly due to delayed diagnosis and treatment. In community practice, Drug-induced Vasculitis (DIV) is frequently overlooked. When patients present with skin rash, fever, and multi-organ dysfunction, DIV should be considered, particularly in the context of recent drug use. Over-the-counter antifungals, like terbinafine or itraconazole, can cause DIV and may be fatal if not promptly diagnosed and treated.