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Medical Forum / Diseases and Disorders / Lupus / March 2009

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Hydroxychloroquine reaction

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George Parton - 04 Feb 2009 14:08 GMT
Hi y'all,

After many, many years of taking Hydroxychloroquine (plaquinil) my
rheumy informs me I am now allergic to the stuff.

I have always experienced skin discoloration on my hands as a side
effect and when it got to the deep purple, nearly black stage I would
cut back the dosage by half.  It has also left permanent discoloration
on my upper left arm as well.

Recently I have had extreme swelling in my right hand extending up my
forearm to the elbow with redness that appears like the blood is ready
to just burst out accompanied by a dry rash.

The most unusual thing is my arm has on more than one occasion started
weeping clear fluid from spots.  Once it was from a small nick received
picking lemons but the other times it appears to just seep from a spot.
 I'm talking lots of fluid here.

We were out to dinner when I noticed the entire lower right arm of my
sweater was soaked.  I thought maybe I had placed it in some spillage
but it didn't seem to want to dry out.  After getting home I discovered
I had sprung another leak!

Anyhow, my rheumy says I have "erythematous urticarial rash".  For this
she prescribed "Triamcinolone ointment" with the warning about adding
even more steroids to my regimen. Of course, now Hydroxychloroquine is
added to my allergy list.

We will see what happens.

On another note.  I have been receiving infusions of "Pamidronate" for
my bone density and much prefer it to being sick from the oral meds that
I took so long. The infusion is supposed to be quite effective. We will see.

Enough about me.

George
Andy - 04 Feb 2009 17:00 GMT
>Hi y'all,
>
>After many, many years of taking Hydroxychloroquine (plaquinil) my
>rheumy informs me I am now allergic to the stuff.

[]

Could it be some component of the mix, not the active drug? Carrier or
preservative?

>On another note.  I have been receiving infusions of "Pamidronate" for
>my bone density and much prefer it to being sick from the oral meds
>that I took so long. The infusion is supposed to be quite effective.

That's my info too.

I believe that the course is 3 or 4 infusions, and either cannot be
repeated or is ineffective if it is.
Signature

Andy Taylor [Chair, N E Lupus Group].
<URL:http://www.northeastlupus.org.uk>

Ruth - 18 Feb 2009 18:20 GMT
> Hi y'all,
>
[quoted text clipped - 34 lines]
>
> George

Hi George, How are you doing after over a week of no  plaquinal? Right
now my left hand
is swollen and purple  but the Doctor yesterday did not suggest giving
up the plaquinil
just upping the prednisone.  Have taken plaquinil for over 25 years
with no bad
results except for big purple blotches on my hands and arms....Always
had an ambition
to be a super show-girl in Vegas   but guess I had better give up that
dream          ruth
George Parton - 19 Feb 2009 05:54 GMT
>>Hi y'all,
>>
[quoted text clipped - 45 lines]
> to be a super show-girl in Vegas   but guess I had better give up that
> dream          ruth

Hi Ruth,
First, don't give up on the showgirl thing.  That is why they make those
long gloves with all the sparkles and stuff!

As for the arm, the swelling has gone down, the discoloration persists
as well as the blood red look.  It also itches.  I'm not totally
convinced this can all be blamed on the plaquinil.  It is easy to pick
that considering my past experience with the discoloration reducing when
the dosage was reduced.

BTW, do your purple blotches ever lighten up and did the prednisone
increase help.  How much prednisone do you take?

That's it from here, thanks for checking in to share your story.

George
blades49456 - 20 Feb 2009 00:06 GMT
I don't have lupus, but my understanding is that erythematous urticarial
 rash is a descriptive term but doesn't detect the underlying cause.

Some autoimmune vasculitis patients have rashes like that.  You might
want to check with your rheumatologist to see if perhaps you've
developed a vasculitis.  Patients who have one autoimmune disease
(lupus) are more likely to develop a second one than are those without
an autoimmune disease.

Probably a wild goose chase, but might be worth checking.  Vasculitides
are notorious for mimicking many other conditions and are difficult to
diagnose as there's no 100% test other than biopsy done in the right way
(enough samples, deep enough, etc.) and even those are sometimes falsely
negative because the pathologist doesn't recognize vasculitis).

Bruce (WG '97)
George Parton - 20 Feb 2009 06:37 GMT
> I don't have lupus, but my understanding is that erythematous urticarial
>  rash is a descriptive term but doesn't detect the underlying cause.
[quoted text clipped - 12 lines]
>
> Bruce (WG '97)

Bruce, you are correct. I have been diagnosed with vasculitis.  Biopsy
removed a blood vessel from my temple area.  I am surprised that my
Rheumy hasn't mentioned this.  Maybe it is because she remembered my
previous experiences with the plaquinil.

Thank you for your great info!

George
J - 08 Mar 2009 19:28 GMT
> Hi y'all,
>
[quoted text clipped - 34 lines]
>
> George

George,
My book called "Worst Pills, Best Pills II...an older adult's guide to Avoiding
Drug induced death or illness"  for Plaquenil
lists dark discoloration of  the skin, nails or inside of mouth, skin rash or
itching,  also mentions unusual bleeding or bruising

Before you Use this drug tell your doctor if you have or have had
allergies to drugs
alcohol dependence
liver problems
severe blood disorders
gastrointestinal disease
glucose-5-phosphate dehydrogenase deficiency
disorders of the nervous system or seizures
psoriasis
eye diseases

Do not drink this alcohol.
___________________________________________________________
Pamidronate
http://www.pamidronate.com/index.jsp?usertrack.filter_applied=true&NovaId=785277
3814828979568#isi


In post-marketing experience, severe and occasionally incapacitating bone,
joint, and/or muscle pain has been reported in patients taking bisphosphonates.

The most common adverse events in bone metastases clinical trials regardless of
causality were as follows: Fluid overload, generalized pain, hypertension,
abdominal pain, anorexia, constipation, nausea, vomiting, urinary tract
infection, bone pain, fever, back pain, arthrosis, headache, anemia,
hypocalcemia, arthralgias, myalgias, and dyspnea.

Caution is advised when IV bisphosphonates are administered with potentially
nephrotoxic drugs.

Patients should be administered an oral calcium supplement of 500 mg and a
multiple vitamin containing 400 IU of vitamin D daily.

Click here for full prescribing information.
http://www.pharma.us.novartis.com/product/pi/pdf/aredia.pdf'
---------------------------------------------------------
When I first read your description it, reminded me of a cancer patient, who had
fluids leaking out of almost every area of his pelois and legs.  I was thinking
edema, lymphedma... or a clot in your arm, combined with the fluid leaking or
infection. If it's dark you would not be able to see red streaks that are a
classic sign of a very serious infection (I forget the name).
Maybe you should run these by someone at ER?  Surely they could rule some things
out and give you an opinion about what's happening?

J - wondering if part of the problem was from the Plaquenil and part of the
problem is the Pamidronate
George Parton - 09 Mar 2009 22:01 GMT
>>Hi y'all,
>>
[quoted text clipped - 85 lines]
> J - wondering if part of the problem was from the Plaquenil and part of the
> problem is the Pamidronate

Thank you again for your input.

This why I have appreciated this NG so much through the years.  You all
are so on top of these things.

In this case the symptoms you describe are right on.

  Plaquenil- eye diseases & nervous system..

  Pamidronate- Fluid overload, generalized pain, hypertension,
  back pain, myalgias, and dyspnea.

As for the vitamin D, I have just received a notice that I will be
 sent some Vitamin D pills which I am to take one per week for 8 weeks.
This is after a collaberation between my Rhuemy, primary care doc and
the nutrition doctor ( I didn't know such a thing existed but she is a
real doctor). Apparently the leaking from the skin is tied to the edema
and discoloration which I am convinced is Vasculitis.  Also I am dumping
protein and am low on phosphorous.

I continue to be amazed that you can put your finger on these things.

Thank you and all of the others who share their expertise.

George
 
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