Cutaneous vasculitis secondary to levamisole treatment in the nephrotic syndrome in paediatrics

Authors

  • Félix Sánchez Bernaldo Unidad de Nefrología Pediátrica. Hospital Materno-Infantil. Granada
  • Beatriz Bravo Mancheño Unidad de Reumatología Pediátrica. Hospital Materno-Infantil. Granada
  • Mª Amelia Gómez Llorente https://orcid.org/0000-0002-6662-8939
  • Ana María Ortega Morales Unidad de Nefrología Pediátrica. Hospital Clínico Universitario San Cecilio. Granada
  • Maria Belén Sevilla Pérez Unidad de Reumatología Pediátrica. Hospital Clínico Universitario San Cecilio. Granada
  • Maria Amelia Gómez Llorente Unidad de Nefrología Pediátrica. Hospital Materno-Infantil. Instituto de Investigaciones Biosanitarias, ibs. GRANAD

Keywords:

Nephrotic syndrome, levamisole, cutaneous vasculitis

Abstract

Introduction: Nephrotic syndrome (NS) is a common childhood glomerular disease. The most common presentation in paediatric population is the idiopathic syndrome (INS). Treatment with levamisole is effective in frequent relapsing and corticosteroid-dependent NS. Studies have reported mild and rarely severe side effects, which subside after treatment withdrawal.

Results: We describe two clinical cases of frequently relapsing INS treated with levamisole that presented with cutaneous vasculitis with positive anti-neutrophil cytoplasmic antibodies. Both cases had skin lesions that disappeared after withdrawal of the drug, avoiding the use of other treatments with corticosteroids, immunomodulators and even amputations due to skin necrosis.

Conclusions: It is important to know the possible complications of levamisole treatment in paediatric patients with INS to proceed with drug withdrawal for resolution.

Downloads

Download data is not yet available.

References

Veltkamp F, Fensma LR, Bouts AHM. Incidence and relapse of idiopathic nephrotic sundrome: meta análisis. Pediatrics. 2021; 148:e202002949. Doi: 10.1542/peds.2020-029249

Vivarelli M, Gibson K, Sinha A, Boyer O. Childhood nephrotic syndrome. Lancet. 2023; 402: 809-24. Doi: 10.1016/S0140-6736(23)01051-6.

Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroidsensitive nephrotic syndrome. Pediatr Nephrol .2022, 38: 877-919. Doi:10.1007/s00467-022-05739-3

Gruppen MP, Bouts AH, Jansen-van der Weide MC, Merkus MP, Zurowska M, Maternik M. et al. A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome. Kidney Int. 2018, 93(2):510–518. Doi:10.1016/ j.kint.2017.08.011

Mühlig AK, Young LJ, Kemper MJ, Kronbichler A, Won Yang J, Lee JM, et al. Levamisole in Children with Idiopathic Nephrotic Syndrome: Clinical Efficacy and Pathophysiological Aspects. J Clin Med. 2019, 8:860. Doi: 10.3390/jcm8060860

Barbano G, Ginevri F, Ghiggeri GM, Gusmano R. Disseminated autoimmune disease during levamisole treatment of nephrotic syndrome. Pediatr Nephrol. 1999, 13:602–3 doi:10.1007/s004670050753

Dartevel A, Chaigne B, Moachon L, Grenier F, Dupin N, Guillevin L, et al. Levamisole-induced vasculopathy: A systematic review. Semin Arthritis Rheum. 2019, 45: 921-6. doi: 10.1016/j.semarthrit.2018.07.010

Rongioletti F, Ghio L, Ginevri F, Bleidl D, Rinaldi S, Edofonti A, et al. Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children. Br J Dermatol. 1999, 140: 948-51. Doi: 10.1046/j.1365-2133.1999.02833.x

Downloads

Published

2024-09-20

How to Cite

1.
Sánchez Bernaldo F, Bravo Mancheño B, Gómez MA, Ortega Morales AM, Sevilla Pérez MB, Gómez Llorente MA. Cutaneous vasculitis secondary to levamisole treatment in the nephrotic syndrome in paediatrics. Ars Pharm [Internet]. 2024 Sep. 20 [cited 2024 Nov. 20];65(4):374-8. Available from: https://revistaseug.ugr.es/index.php/ars/article/view/30958

Issue

Vol. 65 No. 4 (2024)

Section

Clinical Notes

License

Copyright (c) 2024 Mª Amelia Gómez

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

The articles, which are published in this journal, are subject to the following terms in relation to the rights of patrimonial or exploitation:

  1. The authors will keep their copyright and guarantee to the journal the right of first publication of their work, which will be distributed with a Creative Commons BY-NC-SA 4.0 license that allows third parties to reuse the work whenever its author, quote the original source and do not make commercial use of it.

b. The authors may adopt other non-exclusive licensing agreements for the distribution of the published version of the work (e.g., deposit it in an institutional telematic file or publish it in a monographic volume) provided that the original source of its publication is indicated.

c. Authors are allowed and advised to disseminate their work through the Internet (e.g. in institutional repositories or on their website) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).