Blutal
®, a chondroitin sulfate-iron colloid, is a drug used for the treatment of iron deficiency anemia. Drug eruptions caused by Blutal
® suddenly increased from 1–5 cases/year to 204 cases/year after the chondroitin sulfate source was changed from bovine to shark in November 2005. Blutal
® was recalled in July 2006, and the number of sufferers has not increased since. However, the cause of the drug eruption has not previously been investigated. We encountered 4 cases of drug eruptions caused by Blutal
® between March and May of 2006. In all the cases, we observed punctuate erythema and occasional diffuse erythema along with the presence of small-sized vesicles and pustules in severe lesions. A biopsy of the pustular lesions revealed intraepidermal pustules and spongiosis with perivascular lymphocytic infiltration. We analyzed the chondroitin sulfates sourced from cattle and sharks by 500-MHz proton nuclear magnetic resonance (
1H NMR). Chondroitin sulfate originating in cattle was mainly composed of the H-4 of 4-
O-sulfo-
N-acetylgalactosamine (CSA), and the chondroitin sulfate originating in shark was mainly composed of the H-6 of 6-
O-sulfo-
N-acetylgalactosamine (CSC). It is known that the principal ingredient of human chondroitin sulfate is CSA. Therefore, it is possible that differences in structure with regard to sulfation, molecular weight, etc., caused the drug eruptions.
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