Nonthrombocytopenic Purpura Associated Sequentially with Nifedipine and Diltiazem

Abstract

OBJECTIVE:

To report the case of a patient who developed nonthrombocytopenic purpura sequentially following the administration of nifedipine and diltiazem.

DATA SOURCES:

Case reports, MEDLINE review of pertinent literature, and review of relevant studies.

DATA EXTRACTION:

Data were extracted from direct patient observation and review of laboratory studies and published reports.

DATA SYNTHESIS:

Nonthrombocytopenic purpura secondary to cutaneous vasculitis is a known, although rare, adverse effect of nifedipine. It has not been reported in association with diltiazem. We report the case of a 75-year-old woman in whom a purpuric rash demonstrated by biopsy to be attributable to cutaneous vasculitis developed in the course of nifedipine therapy. The rash disappeared after discontinuation of the drug; however, it recurred when diltiazem therapy was initiated.

CONCLUSIONS:

Nonthrombocytopenic purpura may be associated with diltiazem as well as with nifedipine. When this adverse effect occurs following administration of a calcium-channel blocker, caution is advised in using other agents of the same class.