Amiodarone-induced cutaneous leukocytoclastic vasculitis after cardiac surgery

Objective: To remind physicians and pharmacists of the potential of amiodarone to cause leukocytoclastic vasculitis (LCV) as a potentially serious acute adverse drug reaction, and that the cornerstone of treatment for LCV is identification and removal of the etiologic agent (usually a drug such as amiodarone). Case Summary: A 70-year-old white male who underwent aortic valve replacement developed cutaneous LCV (without serious systemic involvement) 2 days after treatment with amiodarone 800 mg/day was initiated. Amiodarone was discontinued and the rash almost completely resolved within 48 hours. Amiodarone 400 mg/day was restarted 13 days later and arthralgias and palpable purpuric lesions reappeared in the same distribution, but much more extensively, within 2 days. Amiodarone was discontinued and, once again, arthralgias and skin lesions resolved within 1 week. Discussion: Photosensitivity and the development of blue/grey skin pigmentation are the most commonly and classically recognized cutaneous adverse drug reactions (ADRs) of long-term use of amiodarone. LCV, the most common small-vessel necrotizing vasculitis as an acute ADR to amiodarone, is rare, but needs to be considered in day-to-day clinical practice. The Naranjo probability scale suggested a highly probable association between LCV and the use of amiodarone in our patient. Conclusions: To the best of our knowledge, this is the first case report of LCV occurring in a post-cardiac surgery setting with the use of amiodarone. Cardiothoracic surgeons, cardiologists, other treating physicians and pharmacists should be aware of this rare but potentially serious adverse event related to amiodarone.