Isotretinoin
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Granulomatosis with polyangiitis: case report A 14-year-old boy developed granulomatosis with polyangiitis (GPA) during treatment with isotretinoin for acne. The boy, who had multiple treatment resistant acne, eventually started receiving treatment with isotretinoin [route and dosage not stated]. However, approximately 6 weeks later, he developed non-purulent conjunctivitis, fatigue, retrosternal chest pain with dyspnoea, bilateral lower extremity muscle aches and joint pains. He also had exhibited elevated levels of CRP, ESR and rheumatoid factor. The boy’s isotretinoin therapy was discontinued, and his symptoms improved. However, shortly thereafter, he again developed generalised weakness, fatigue, pallor, fever, cough, flank pain, tea coloured urine, chest pain and leg pain. Consequently, he presented to the emergency department. On presentation, he was pallor and had mild tachycardia. Laboratory investigations showed significant anaemia, and elevated levels of CRP, creatinine and creatine kinase. Urinalysis showed large amount of blood and trace protein. A renal ultrasonography showed bilaterally enlarged kidneys. Therefore, he was hospitalised, and nephrology, pulmonology and rheumatology were consulted. A chest CT showed large areas of ground glass attenuation suggestive of pulmonary haemorrhage. His creatinine continued to increase with repeat urine analysis and presence of RBC casts. Later, a renal biopsy was performed, which revealed necrotising/crescentic glomerulonephritis with no significant deposition of immune complexes. Further lab testing showed elevated level of antiproteinase -3 (anti-PR3). Based on the findings, a diagnosis of granulomatosis with polyangiitis was confirmed. The boy received treatment with unspecified steroids and rituximab. Afterwards, his symptoms gradually improved. Author comment: "[T]here have been multiple drugs associated with the development of GPA [granulomatosis with polyangitiis]." "Isotretinoin is one of them and was the likely trigger in the case above." Malone C. Isotretinoin induced granulomatosis with polyangitis. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 405, No. 4, Apr 2018. Available from: URL: https://www.shmabstracts.com/abstract/isotretinoin-induced-granulomatosis803432070 with-polyangitis/ [abstract] - USA
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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