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c-ANCA vasculitis after initiation of denosumab
  1. Alexandra Sanchez,
  2. Matthew Lozier,
  3. Brian Cody Adkinson and
  4. Amro Ilaiwy
  1. University of Miami Miller School of Medicine at Holy Cross Hospital, Fort Lauderdale, Florida, USA
  1. Correspondence to Dr Amro Ilaiwy, amroilaiwy{at}


Denosumab is a fully human antibody to receptor activator of nuclear factor kappa-B ligand (RANKL), and it is administered every 6 months in women with postmenopausal osteoporosis (PMO) at high risk for fracture. Adverse effects of denosumab include musculoskeletal pain, hypercholesterolaemia, symptomatic hypocalcaemia, osteonecrosis of the jaw and cutaneous events such as angioedema, cellulitis and pustular dermatitis. While the possibility of vasculitis was mentioned in the product Monograph as well as in the WHO Newsletter, this is the first case, to our knowledge, of cytoplasmic-ANCA (c-ANCA) associated vasculitis officially published in the literature.1 2 The pathogenic mechanisms behind drug-induced vasculitis remain to be defined and appear to be multifactorial. Once suspicion for drug-induced vasculitis arises, the offending agent should be discontinued and immunosuppressive therapy should be initiated according to the severity of organ involvement to inhibit progression to severe, irreversible disease. As new medications continue to be developed, the number of agents causing drug-induced vasculitis is expected to increase.

  • drug interactions
  • unwanted effects / adverse reactions
  • vasculitis
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  • Contributors This is to certify that all persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the BMJ Journal of Case reports. AS contributions include conception and design of this report, acquisition of data as well as drafting the manuscript. ML and BCA contributions include design of this report and drafting the manuscript. AL contributions include drafting the report as well as critically revising it. All co-authors approve this manuscript for final publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

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