Thalidomide
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Thalidomide Leukocytoclastic vasculitis: case report A 58-year-old man developed leukocytoclastic vasculitis during treatment with thalidomide for multiple myeloma. The man, who had previously received melphalan, prednisolone and radiotherapy, started receiving thalidomide at a dosage of 100 mg/day increased to 200 mg/day after 2 weeks. The treatment was well tolerated so, after 1 month, thalidomide was increased to 400 mg/day; Zoledronic acid was also initiated. After 9 months of treatment with thalidomide, he developed a sudden purpuric exanthema on both lower extremities. The eruptions were palpable, bumpy, tended to gather and did not lose colour on pressure. He also had arthralgia of both knee joints. Urine testing was positive for protein and revealed haematuria with a density of 1014 and a pH of 7.4. Microscopy revealed abundant erythrocytes and leucocytes. Skin punch biopsy of the exanthemas revealed compact keratin layer with surface focal parakeratosis, papillary dermal oedema, neutrophil infiltration, erythrocyte extravasation and leukocytoclasis around small blood vessels; this suggested leukocytoclastic vasculitis. Clinical presentations were compatible with Henoch-Schoenlein purpura. Thalidomide was discontinued and Methylprednisolone was initiated. The man had resolution in arthralgia and purpuric exanthemas after 1 week, and in haematuria and proteinuria after 2 months. Zoledronic acid was continued. After 12 months, thalidomide was not readministered. At subsequent 12-month follow-up, leukocytoclastic vasculitis had not recurred. Author comment: "[Leukocytoclastic vasculitis] is an extremely rare complication of thalidomide therapy, but the autoimmune phenomenon that can occur during treatment with this drug remains to be evaluated." Yildirim ND, et al. Leukocytoclastic vasculitis due to thalidomide in multiple myeloma. Japanese Journal of Clinical Oncology 37: 704-707, No. 9, Sep 2007 801096085 Turkey
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Reactions 5 Jan 2008 No. 1183
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