Abstract: PUB147
Losartan Triggering Immunological Disturbances Leading to IgA Vasculitis (Henoch-Schonlein Purpura) Flare
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Author
- Thimmisetty, Ravi K., Renal Medicine Associates, Albuquerque, New Mexico, United States
Introduction
Losartan potassium is an orally active, nonpeptide angiotensin II type 1 receptor antagonist that has been approved for the treatment of proteinuria in Chronic kidney diseases. We have 71 year old lady with established diagnosis of Leukocytoclastic vasulitis and Ig A Nephropathy. After changing from lisinopril to losartan due to cough, she developed rash 4-6 weeks of change. Biopsy of skin rash showed leukocytoclastic vasculitis. after stopping losartan, rash improved in 2 weeks.
Case Description
71 year old lady with history of Ig A Nephropathy, Ig A vasculitis, and Leukocytoclastic vasculitis came to clinic for purpuric rash. she was taking hydroxychloroquine, losartan. Owing to cough, primary care doctor changed to losartan a month ago. Skin biopsy was done whish showed again Luekocytoclastic vasculitis. Vitals were with in normal range. Laboratory results showed creatinine 0.62 mg/dl, C3, C4 were with in normal range. urinalysis is negative. SS-B and ANA titers were elevated with homogenous pattern ( 6.7, 1:80) compared to previous values (1.3, positive ANA with negative pattern with less then 1:80) There is no travel, no animal bite, no other new medications. Other than mild palpable rash, exam is with in normal. Immediately changed back to lisinopril at a lower dose. Rash resolved slowly in 2-3 weeks after stopping losartan. follow up SS-B, ANA titers were slowly coming down (4.7, negative pattern with less than 1:80)
Discussion
This is an important triggering factor that led her disturbances in immunological function that caused her flare of vasculitis. on review of literature, losartan association with HSP (Henoch- Schonlein purpura) rarely reported.
palpable rash