Mimics of vascular ischaemia: Rare variant of drug-induced vasculitis and associated autoimmune pathogenicity – A report of two cases

Abstract

Drug-induced vasculitis is the inflammation of blood vessels instigated by a pharmaceutical agent and can mimic vascular ischaemia. The inflammatory environment can be acute or chronic. Activation of endothelial cells and coagulation factors predisposes a vessel to thrombosis and ischaemia of the tissues and organs it supplies. An element of autoimmune activation may contribute to the pathogenesis and subsequent clinical manifestation of this condition. We report two cases of peripheral limb ischaemia in patients with a history of psychostimulant use and discuss the investigations undertaken and their subsequent management. Diagnosis of drug-induced vasculitis can be challenging, and a wide variety of other differentials must first be explored. Understanding the pathophysiology underlying drug-induced vasculitis and secondary autoimmune thrombophilia allows for better diagnostic and therapeutic management in this rare cohort of patients.

Keywords

• Vasculitis
• Drug induced vasculitis
• Vascular ischaemia
• Psychostimulant
• Sympathomimetic