Dry gangrene of lower limbs in a child: an adverse drug reaction to chloramphenicol

  • Authors

    • Tanvir Samra PGIMER CHANDIGARH
    • Lalita Chaudhary
    • Ranvinder Kaur
  • Drug induced vasculitis is a potentially life and limb threatening complication which can be precipitated by intake of virtually any pharmaceutical agent. It is a diagnosis of exclusion as definitive diagnostic and laboratory criteria have not been defined. Withdrawal of the offending agent is the definitive therapy but use of antithrombotic, vasodilatory and anti-inflammatory agents has been proven to be beneficial. We report a case of dry gangrene of bilateral lower limbs and digits of the upper limb due to DIV secondary to the intake of chloramphenicol in a child diagnosed with typhoid fever.

    Keywords: Adverse Drug Reaction; Dry Gangrene; Chloramphenicol; Typhoid Fever; Drug Induced Vasculitis.

  • References

    1. Edwards IR and Aronson JK (2000), adverse drug reactions: definitions, diagnosis, and management, Lancet. 356(9237)1255-9. http://dx.doi.org/10.1016/S0140-6736 (00)02799-9.
    2. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, et al. (1994), Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum.37:187-92.http://dx.doi.org/10.1002/art.1780370206.
    3. Doyle MK and Cuellar ML (2003), Drug-induced vasculitis. Expert Opinion on Drug Safety. 2(4) 401–409. http://dx.doi.org/10.1517/14740338.2.4.401.
    4. Radić M, Martinović Kaliterna D, Radić J (2012), Drug-induced vasculitis: a clinical and pathological review. Neth J Med. 70 (1) 12-7.
    5. Bonaci-Nikolic BM, Nikolic MM, Andrejevic S, Zoric S, Bukilica M. (2005), Antineutrophil cytoplasmic antibodies (ANCA)-associated autoimmune diseases induced by antithyroid drugs: Comparison with idiopathic vasculitides. Arthritis Res Ther, 7 (5) R1072–R1081 http://dx.doi.org/10.1186/ar1789.
    6. Herlin T, Birkebaek NH, Wolthers OD, Heegaard NH, Wiik A.(2002) Antineutrophil cytoplasmic antibodies (ANCA) prophiles in propylthiouracil-induced lupus-like manifestations in monozygotic triplets with hyperthyroidism. Scand J Rheumatol, 31 (1) 46–49.http://dx.doi.org/10.1080/030097402317255381.
    7. Storsley L and Geldenhuys L.(2007) Ciprofloxacin-induced ANCA-negative cutaneous and renal vasculitis--resolution with drug withdrawal.Nephrol Dial Transplant.,22(2) 660-1. http://dx.doi.org/10.1093/ndt/gfl554.
    8. Calabrese LH, Michel BA, Bloch DA, Arend WP, Edworthy SM, Fauci AS,et al. (1990) The American College of Rheumatology 1990 criteria for the classification of hypersensitivity vasculitis. Arthritis Rheum. 1990; 33(8)1108–1113. http://dx.doi.org/10.1002/art.1780330808.
    9. 9. Haber MM, Marboe CC, Fenoglio JJ. Vasculitis in drug reactions and serum sickness. In: Churg A, Churg J (eds). Systemic Vasculitides. New York: Igaku-Shoin; 1991. pp. 305–311.
    10. Tsai MH, Yang JH, Kung SL, Hsiao YP. (2013) Levamisole-induced myopathy and leukocytoclastic vasculitis: a case report and literature review. Dermatol Ther. 26 (6) 476-80 http://dx.doi.org/10.1111/dth.12018.
    11. Eyre TA, Gooding S, Patel I, Moore N, Hatton C, Collins GP. (2014) Gemcitabine-induced large vessel vasculitis demonstrated by PET CT: a rare, important side effect. Int J Hematol. 99(6):798-800 http://dx.doi.org/10.1007/s12185-014-1555-5 .
    12. Harada N, Okajima K, Uchiba M. (2006) Dalteparin, a low molecular weight heparin, attenuates inflammatory responses and reduces ischaemia-reperfusion-induced liver injury in rats. Crit Care Med 2006; 34(7) 2011–3. http://dx.doi.org/10.1097/01.CCM.0000220764.10155.03.
    13. Jeffery RC, Narshi CB, Isenberg DA. (2008) Prevalence, serological features, response to treatment and outcome of critical peripheral ischaemia in a cohort of lupus patients. Rheumatology, 47 (9) 1379-83. http://dx.doi.org/10.1093/rheumatology/ken210.
    14. Rubenstein E, Arkfeld DG, Metyas S, Shinada S, Ehresmann S, Liebmann H. (2006), Rituximab treatment for resistant antiphospholipid syndrome. J Rheumatol, 33(2) 255–7.
    15. Das U, (2000), Multidrug resistant Salmonella typhi in Rourkela, Orissa. Indian J Pathol Microbiol, 43(2)135-8.
    16. Balbi H (2004) Chloramphenicol: A Review. Pediatrics in Review, 25:284-88. http://dx.doi.org/10.1542/pir.25-8-284.
  • Downloads

    Additional Files

  • How to Cite

    Samra, T., Chaudhary, L., & Kaur, R. (2014). Dry gangrene of lower limbs in a child: an adverse drug reaction to chloramphenicol. International Journal of Pharmacology and Toxicology, 2(2), 101-103. https://doi.org/10.14419/ijpt.v2i2.3299