Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Adverse events of drug therapy , Educational Purpose (only if useful for a systematic review or synthesis)
Bibi Ayesha, Jimmy Varghese, Haraldine Stafford
(Department of Internal Medicine, Division of Rheumatology, Montefiore Medical Center, Bronx, USA)
Am J Case Rep 2019; 20:489-492
Clopidogrel is an antiplatelet medication that plays an important role in primary management and secondary prevention of thrombotic vascular events in patients with acute coronary syndrome. It is generally well tolerated by most patients, but rare adverse effects such as inflammatory arthritis has been noted. A very few cases of migratory polyarthritis secondary to clopidogrel have been reported in the literature.
CASE REPORT: We describe 2 cases of acute migratory polyarthritis associated with clopidogrel that resolved with discontinuation of clopidogrel and did not recur after prasugrel initiation. In the first case, the patient presented with migratory polyarthritis approximately 2-3 days after initiating clopidogrel, and the symptoms lasted in each joint for 1-2 days. In the second case, the migratory polyarthritis started 1 week after initiating clopidogrel, and the symptoms lasted in each joint for approximately 2-3 days. The symptoms completely resolved after discontinuing clopidogrel in both the cases, which is typical of an immune-mediated drug reaction. A diagnosis of acute migratory inflammatory polyarthritis related to clopidogrel was determined in both cases by excluding other conditions causing inflammatory arthritis. In both cases, the eosinophil count was within normal limits, thereby differentiating the disease process from an acute allergic reaction.
CONCLUSIONS: Identifying the etiology of inflammatory arthritis in a patient on clopidogrel needs extensive evaluation. The diagnosis of clopidogrel-related inflammatory arthritis is often missed due to lack of awareness. Early diagnosis and timely intervention are essential, as the symptoms completely resolve after discontinuing clopidogrel.
Keywords: Arthritis, Platelet Aggregation Inhibitors, thienopyridines