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Puac-Polanco P, Rovira À, Shah LM, Wiggins RH, Rivas Rodriguez F, Torres C. Imaging of Drug-Related Vasculopathy. Neuroimaging Clin N Am 2024; 34:113-128. [PMID: 37951697 DOI: 10.1016/j.nic.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Illicit and recreational drugs, such as cocaine, heroin, amphetamines, and marijuana, can result in drug-related vasculitis or vasculopathy. Similarly, the use of certain antithyroid, oncologic, and immunosuppressive medications for therapeutic purposes can lead to vasculopathy. This in turn may result in significant complications in the central nervous system, including intracranial hemorrhage and stroke. Cocaine abuse can also lead to midline destructive lesions of the sinonasal complex. MR imaging, Vessel Wall imaging, and CT/CTA are valuable imaging tools for the evaluation of patients with suspected drug-induced vasculopathy or vasculitis. This article reviews the pathomechanism, clinical presentation, and imaging findings of vasculopathy related to drug abuse and prescribed medications.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Vall d'Hebron Passeig Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Lubdha M Shah
- Division of Neuroradiology, University of Utah, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Richard H Wiggins
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, University of Utah Health Sciences Center, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Francisco Rivas Rodriguez
- Radiology, Division of Neuroradiology, University of Michigan, 1500 East Medical Center Drive, B2A205 Ann Arbor, MI 48109-5302, USA
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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Hawn VS, Vo TA, Flomenbaum D, Gibralter RP. Hydralazine-induced vasculitis presenting with ocular manifestations. Am J Ophthalmol Case Rep 2022; 26:101515. [PMID: 35464686 PMCID: PMC9020102 DOI: 10.1016/j.ajoc.2022.101515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vivian S. Hawn
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, NY, 10461, Bronx, USA
| | - Thomas A. Vo
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, 111 East 210th Street, NY, 10467, Bronx, USA
| | - David Flomenbaum
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, NY, 10461, Bronx, USA
| | - Richard P. Gibralter
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, 111 East 210th Street, NY, 10467, Bronx, USA
- Corresponding author. 3332 Rochambeau Avenue, Bronx, NY, 10467-2836, USA.
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Giraud-Kerleroux L, Bernigaud C, Droumaguet C, Thai LH, Marciano-Fellous L, Thomas L, Charpentier C, Helbert-Davidson S, Fardet L, Hüe S, Ingen-Housz-Oro S. [Purpura in a young woman with hyperthyroidism]. Rev Med Interne 2021; 42:509-512. [PMID: 33846035 DOI: 10.1016/j.revmed.2021.03.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Propylthiouracil (PTU) is a synthetic antithyroid drug that can induce ANCA-associated vasculitis. OBSERVATION A 27-year-old woman diagnosed with Graves' disease was on PTU for the past 10 years. She developed purpuric lesions of the legs and on the tip of the nose diagnosed as vasculitis. ANCAs were positive, with anti-MPO and anti-PR3 on blood ELISA. After discontinuation of PTU, she was able to fully recover. CONCLUSION All synthetic antithyroid drugs can induce ANCA-associated vasculitis, more often PTU. In most cases, antibodies are directed against MPO. Dual anti-MPO and anti-PR3 positivity is possible, but rare. The mechanism could be through an accumulation of PTU in neutrophils, altering the structure of MPO and making it immunogenic. PTU can also induce ANCA-free or lupus vasculitis, maculopapular rashes or urticaria. Many other drugs can induce ANCA-associated vasculitis.
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Affiliation(s)
- L Giraud-Kerleroux
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - C Bernigaud
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - C Droumaguet
- Service d'endocrinologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - L H Thai
- Service de médecine interne, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - L Marciano-Fellous
- Service d'anatomopathologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - L Thomas
- Centre régional de pharmacovigilance, hôpital Henri Mondor, AP-HP, Créteil, France
| | - C Charpentier
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - S Helbert-Davidson
- Service de médecine nucléaire, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - L Fardet
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - S Hüe
- Laboratoire d'immunologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; UPEC, université Paris Est Créteil EpidermE, Créteil, France.
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