Three Cases Resembling Polyarteritis Nodosa Arising during Treatment with Guanethidine.

Widespread inflammation of the walls of small arteries, either in the form of classical polyarteritis nodosa or as a generalized arteritis, has been described as a result of sensitization of the human body to a variety of antigens. Many of these have not been of a protein nature, and then it is assumed that the incriminated substance has acquired its antigenic properties by becoming linked to a protein in the plasma. Drugs suspected of being incriminated in this way have included antibiotics such as chloramphenicol (Rose and Spencer, 1957), penicillin (Waugh, 1952; Winton and Nora, 1955), streptomycin (Edge et al., 1955); sulphonamides (Rose and Spencer, 1957; Lichtenstein and Fox, 1946); organic arsenic compounds (Miller and Daley, 1946); barbiturates (Meyler et al., 1960); chlorpromazine (Symmers, 1958); corticosteroids (Slocumb et al., 1957; Rose and Spencer, 1957); D.D.T. (Hill and Damiani, 1946); hydantoin derivatives (Van Wyk and Hoffman, 1948); hydrallazine (Symmers, 1962); iodides (Rasmussen, 1955); metals such as bismuth (Rose and Spencer, 1957), gold (Meyler et al., 1960), and mercury (Winton and Nora, 1955); phenylbutazone (Hodge and Lawrence, 1957) ; quinidine (Symmers, 1962) ; and uracil compounds (McCormick, 1950; Dalgleish, 1952). There are doubtless others, but we have not been able to find any reference to guanethidine as the antigen in an allergic vasculitis. In the following three cases it seems possible that it has been the responsible factor.