Title:Case Report of Sotalol Induced IgA Vasculitis
Volume: 19
Issue: 1
Author(s): Biniyam T. Mohammed*, Marwah Alchalabi, Anna Laskova, Chenyu Sun, Owais Lodhi, Yasmin Gerais and Ayah Galal Abdelrahman Alkhidir
Affiliation:
- Internal Medicine Department, Amita Health St Joseph Hospital, Chicago, Illinois, USA
Keywords:
Vasculitis, IgA, sotalol, RMSF, drug-induced, arthralgias.
Abstract: Background: IgA vasculitis is the most common form of systemic vasculitis in children
but can occur in adults. Inciting antigens include infections, drugs, foods, insect bites, and immunizations.
Antibiotics and tumor necrosis factor (TNF) alpha inhibitors are the most common class of
drugs that cause IgA vasculitis. Although sotalol and rivaroxaban have been documented to cause
leukocytoclastic vasculitis, we have never come across any literature attributing IgA vasculitis to
either drug. Additionally, Rocky Mountain spotted fever has not been associated with IgA vasculitis
despite being described in cutaneous and systemic vasculitis cases. Here, we present a case of IgA
vasculitis triggered by sotalol with challenging differentials, including a recent infection with Rocky
Mountain spotted fever, malignancy, and rivaroxaban as possible triggers.
Case Presentation: 68 yr old male with a history of lung cancer treated with resection and chemotherapy
5 years ago is currently in remission, and recently was started on sotalol and rivaroxaban for
new-onset paroxysmal atrial fibrillation. He presented with diffuse petechial/purpural rash on the
lower limbs, multiple joint pain, severe abdominal pain and rectal bleeds, hemoptysis, and renal
dysfunction. IgG titers for RMSF were high. Punch biopsy of skin and renal biopsy were consistent
with IgA vasculitis. Sotalol and rivaroxaban were stopped. The patient was treated with oral prednisone,
and his condition relatively improved.
Conclusion: Ig A vasculitis is mostly a self-limiting disease, but adults tend to have a severe
course. It is important to diagnose early and identify a trigger. Removing the offending agent or
treating the underlying infection is an important aspect of management.
