The online version of this article (doi:10.1186/1752-1947-8-76) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AN, AC, AP and BM cared for our patient during her hospital stay. AP and LM reviewed our patient’s diagnostic history, signs, laboratory data and investigations, and made the diagnosis. AN and GM wrote the manuscript and performed a literature search. All authors have read, edited and approved the final manuscript.
The most common adverse effects associated with bisphosphonates are renal toxicity, acute-phase reactions, gastrointestinal toxicity, osteonecrosis of the jaw, transitory fever and uveitis. We report a unique adverse case of vasculitis induced by clodronate.
A 61-year-old Caucasian woman developed bilateral renal ischemia after kyphoplasty and clodronate treatment for lumbar vertebral fracture. Tests revealed a vasculitis due to clodronate treatment. The antithrombotic and immunosuppressive drugs allowed us to reduce the extent of the renal ischemia. In the following months the increased auto-antibodies returned to the healthy physiological range, but the chronic renal failure persisted.
Drug-induced vasculitis is an inflammation of blood vessels caused by the use of various pharmaceutical agents. The spectrum of drug-induced vasculitis can range from cutaneous rashes to fatal multi-organ involvement. To the best of our knowledge this is the first documented case of drug-induced vasculitis caused by clodronate in the literature. Previously, it was verified that clodronate injection could increase the pro-apoptotic action on immune cells. Further studies are necessary to clarify the role of bisphosphonates on drug-inducing vasculitis.
Lehenkari PP, Kellinsalmi M, Näpänkangas JP, Ylitalo KV, Mönkkönen J, Rogers MJ, Azhayev A, Väänänen HK, Hassinen IE: Further insight into mechanism of action of clodronate: inhibition of mitochondrial ADP/ATP translocase by a nonhydrolyzable, adenine-containing metabolite. Mol Pharmacol. 2002, 62: 1255-1262. CrossRef
Rovetta G, Maggiani G, Molfetta L, Monteforte P: One-month follow-up of patients treated by intravenous clodronate for acute pain induced by osteoporotic vertebral fracture. Drugs Exp Clin Res. 2001, 27: 77-81. PubMed
Thomson KR, Varma K: Safe use of radiographic contrast media. Aust Prescr. 2010, 33: 19-22. CrossRef
Pitton MB, Drees P, Schneider J, Brecher B, Herber S, Mohr W, Eckardt A, Heine J, Thelen M: [Evaluation of percutaneous vertebroplasty in osteoporotic vertebral fractures using a combination of CT fluoroscopy and conventional lateral fluoroscopy]. Rofo. 2004, 176: 1005-1012. 10.1055/s-2004-813191. CrossRefPubMed
Cacciapaglia F, Spadaccio C, Gregorj C, Margiotta D, Coccia R, De Marco F, Chello M, Picardi A, Amoroso A, Afeltra A: Apoptosis and autoimmunity induced by clodronate in systemic lupus erythematosus mononuclear circulating cells. Int J Immunopathol Pharmacol. 2010, 23: 535-542. PubMed
Bonaci-Nikolic B, Nikolic MM, Andrejevic S, Zoric S, Bukilica M: Antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune diseases induced by antithyroid drugs: comparison with idiopathic ANCA vasculitides. Arthritis Res Ther. 2005, 7: R1072-R1081. 10.1186/ar1789. CrossRefPubMedPubMedCentral
- Bilateral renal ischemia after kyphoplasty and clodronate treatment: a case report
- BioMed Central