Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

A Case Report on Amlodipine-Induced Petechiae Mohammed Almamun, MD., MSc; Matta Reddy, MD Family Medicine Residency Program Graduate Medical Education, Aiken Regional Medical Centers, Aiken, SC

Inclusive Training. Compassionate Care.

METHODS The Case presentation and data were obtained directly from the patient during the ER encounter and electronic medical records (EMR). We had removed all the patient identifying information before adding it to this report

INTRODUCTION

DISCUSSION

CONCLUSIONS • Amlodipine-induced petechiae is a rare but noteworthy adverse reaction to Amlodipine use. • A type of Pigmented purpuric dermatoses (PPD) called Schamberg’s disease (SD) has also been seen by Amlodipine use. [2] • Petechiae usually <2mm in size and has pinpoint spots; Purpura usually 2-10 mm in size and has irregular spots. • Only 2-3 cases have been reported so far for the Amlodipine-induced petechiae or Schamberg’s disease • The skin lesions are asymptomatic and mostly located on the lower extremities. • Amlodipine causes vasodilation, which might increase capillary fragility and lead to microvascular leakage. • The skin lesions occur due to erythrocytes breaking down outside the capillary from the leakage which leads to hemosiderin depositions. • The primary treatment is to discontinue the Amlodipine. • In this case report, our patient discontinued the Amlodipine two days before coming to the ER and noticed some improvements in her skin condition. • The patient was asymptomatic other than petechiae • The blood work for platelet count, liver function tests, CRP, coagulation factors, blood culture and Chest X-ray were normal. • Based on history and presentation, it was concluded that the patient was having Amlodipine-induced petechiae. • The patient was advised to discontinue Amlodipine use and follow up with her PCP in 1-2 days for alternative hypertension management. • Amlodipine-induced petechiae, though rare, highlights the need for clinicians to be vigilant about potential adverse drug reactions. • Prompt recognition of the condition, discontinuation of Amlodipine, and appropriate management are critical to ensure patient safety and symptom resolution. • Substitution with an alternative antihypertensive medication is typically required to maintain blood pressure control. • Regular follow-ups are essential to prevent recurrence and optimize treatment outcomes, providing reassurance and confidence in patient care. • Continued research and case reporting can enhance understanding of this rare adverse reaction and improve clinical decision-making.

CASE DESCRIPTION • Hypertension affects almost one-half the U.S. adult population according to Centers for Disease Control and Prevention (CDC). • 51% of those patients take medications to lower their BP • Amlodipine, a calcium channel blocker (CCB), is a widely prescribed medication for controlling Hypertension and angina. • Amlodipine acts by relaxing the smooth muscles in blood vessel walls, reducing vascular resistance and blood pressure. • Amlodipine is generally well-tolerated, besides some common side effects such as peripheral edema, dizziness, flushing, headache, fatigue, and palpitation. • Petechiae are small, pinpoint, non-blanching spots that appear on the skin or mucous membranes due to minor bleeding under the skin. These lesions can be a symptom of various conditions, including drug reactions. • In rare cases, Amlodipine can cause Amlodipine-induced petechiae and Progressive Pigmentary Purpura, also known as Schamberg’s disease (SD), a type of Pigmented purpuric dermatoses (PPD). • We are presenting a case of a patient who developed lower extremities petechiae after amlodipine use. • A 77-year-old wheelchair-bound female with a past medical history of recent CVA with right residual weakness, diabetes, Hypertension, and hyperlipidemia presented to the emergency room (ER) with a complaint of a 10-day history of painless, non blanching pinpoint petechiae rash on her bilateral lower extremities. • The patient’s blood pressure medication was switched from diltiazem (120mg) to Amlodipine (5mg) around 10 days ago by her PCP for better hypertension management. • Additionally, the patient is taking Plavix and aspirin for her recent CVA. • The patient denies any injury to her lower extremities, fever, chills, or other complaints. • Blood work for platelet count, LFT, CRP, coagulation factors, Blood culture, and CXR were unremarkable.

IMAGES

(A) (B) Figure: A) Skin lesion due to amlodipine use; B) Skin lesions after cessation of amlodipine. [1] (images are not from the actual patient of this case report)

TREATMENT

• The primary treatment is to address the underlying cause (amlodipine use) and symptoms management • Discontinuation of Amlodipine and alternative medical management for Hypertension • Symptomatic management such as observation, using emollient/soothing agent, or topical steroid use depending on the severity of the case • Rule out any underlying medical conditions like thrombocytopenia, bruising, or bleeding disorders • Patient education about the potential for similar reactions and prevention.

REFERENCES

1. Faria C, Henriques F, Leite J, Fernandes C. Purpura is Not Always Caused by the Anticoagulant. Eur J Case Rep Intern Med. 2017;4(3):000536. Published 2017 Apr 27. doi:10.12890/2017_000536 2. Schetz D, Kocić I. A new adverse drug reaction--Schamberg's disease caused by amlodipine administration--a case report. Br J Clin Pharmacol. 2015;80(6):1477-1478. doi:10.1111/bcp.12742

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