The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis

Leukocytoclastic vasculitis is a rare form of immune-mediated vasculitis that might be caused by infections or autoimmune diseases or might be precipitated by specific medications. We describe a 65-year-old patient, who was receiving vancomycin for a methicillin-sensitive Staphylococcus aureus perma...

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Main Authors: John A. Zadroga, Vanajakshi Mogulla, Christopher Grant, Djordje Jevtic, Andrew Virata, Igor Dumic
Format: Article
Language:English
Published: Hindawi Limited 2021-01-01
Series:Case Reports in Infectious Diseases
Online Access:http://dx.doi.org/10.1155/2021/9932425
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spelling doaj-00c7d44397f6402fb117a50718249dc02021-06-21T02:24:24ZengHindawi LimitedCase Reports in Infectious Diseases2090-66332021-01-01202110.1155/2021/9932425The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic VasculitisJohn A. Zadroga0Vanajakshi Mogulla1Christopher Grant2Djordje Jevtic3Andrew Virata4Igor Dumic5Family Medicine Residency ProgramDivision of Hospital MedicineMedical College of WisconsinUniversity of BelgradeDivision of Hospital MedicineDivision of Hospital MedicineLeukocytoclastic vasculitis is a rare form of immune-mediated vasculitis that might be caused by infections or autoimmune diseases or might be precipitated by specific medications. We describe a 65-year-old patient, who was receiving vancomycin for a methicillin-sensitive Staphylococcus aureus permacath infection. Vancomycin was chosen due to medication non-adherence and the patient’s desire to receive antimicrobial therapy in conjunction with his scheduled dialysis sessions. The patient’s medical history was notable for untreated hepatitis C infection and end-stage renal disease, requiring hemodialysis three times a week. Vancomycin was administered during dialysis sessions. After one week of therapy, the patient developed bilateral lower extremity purpura. Skin biopsy was suggestive of leukocytoclastic vasculitis with an absence of intravascular thrombi. Serum cryoglobulins were negative, making cryoglobulinemia due to HCV infection unlikely. Following cessation of vancomycin therapy, the rash gradually disappeared with scarring in the form of post-purpuric hyperpigmentation. Despite its widespread use, vancomycin is a rare cause of leukocytoclastic vasculitis. Clinicians should keep in mind a wide range of differential diagnosis of bilateral lower extremity purpura as treatment differs depending on its underlying etiology.http://dx.doi.org/10.1155/2021/9932425
collection DOAJ
language English
format Article
sources DOAJ
author John A. Zadroga
Vanajakshi Mogulla
Christopher Grant
Djordje Jevtic
Andrew Virata
Igor Dumic
spellingShingle John A. Zadroga
Vanajakshi Mogulla
Christopher Grant
Djordje Jevtic
Andrew Virata
Igor Dumic
The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
Case Reports in Infectious Diseases
author_facet John A. Zadroga
Vanajakshi Mogulla
Christopher Grant
Djordje Jevtic
Andrew Virata
Igor Dumic
author_sort John A. Zadroga
title The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
title_short The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
title_full The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
title_fullStr The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
title_full_unstemmed The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis
title_sort many faces of purpura: vancomycin-induced leukocytoclastic vasculitis
publisher Hindawi Limited
series Case Reports in Infectious Diseases
issn 2090-6633
publishDate 2021-01-01
description Leukocytoclastic vasculitis is a rare form of immune-mediated vasculitis that might be caused by infections or autoimmune diseases or might be precipitated by specific medications. We describe a 65-year-old patient, who was receiving vancomycin for a methicillin-sensitive Staphylococcus aureus permacath infection. Vancomycin was chosen due to medication non-adherence and the patient’s desire to receive antimicrobial therapy in conjunction with his scheduled dialysis sessions. The patient’s medical history was notable for untreated hepatitis C infection and end-stage renal disease, requiring hemodialysis three times a week. Vancomycin was administered during dialysis sessions. After one week of therapy, the patient developed bilateral lower extremity purpura. Skin biopsy was suggestive of leukocytoclastic vasculitis with an absence of intravascular thrombi. Serum cryoglobulins were negative, making cryoglobulinemia due to HCV infection unlikely. Following cessation of vancomycin therapy, the rash gradually disappeared with scarring in the form of post-purpuric hyperpigmentation. Despite its widespread use, vancomycin is a rare cause of leukocytoclastic vasculitis. Clinicians should keep in mind a wide range of differential diagnosis of bilateral lower extremity purpura as treatment differs depending on its underlying etiology.
url http://dx.doi.org/10.1155/2021/9932425
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