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Delineating them is a daunting task. This update aims to consolidate clinical evidence focussing on characteristic \u201cvascular signatures\u201d using advanced multimodal imaging tools. Type III (immune complex-mediated) and Type IV (T-cell-mediated) hypersensitivity pathways were involved in diverse range of drugs causing DRIV. The critical therapeutic strategies are highlighted to prevent permanent ischemic damage. 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