Vasculite leucocitoclástica cutânea associada à tuberculose pulmonar

Moon

Allergy Asthma Immunol Res

et al. 2010

Anti-tuberculosis drugs frequently result in cutaneous adverse reactions, including pruritus, maculopapular exanthems, and urticaria. However, anti-tuberculosis drug-associated cutaneous leukocytoclastic vasculitis (CLV) has been rarely reported. We describe a case of CLV induced by rifampin and pyrazinamide. A 38-year-old male had been diagnosed with pulmonary tuberculosis two months ago and then he started standard anti-tuberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide. Purpuric lesions developed in the extremities after 1.5 months of anti-tuberculosis medication; the lesions progressively spread over the entire body. Histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after cessation of anti-tuberculosis medications and treatment with oral corticosteroids and antihistamines. Anti-tuberculosis drugs were rechallenged one at a time over 3 days. Purpura recurred on the right forearm and forehead after taking 300 mg of rifampin. The skin lesion disappeared after taking oral prednisolone. Finally, 1,500 mg of pyrazinamide was readministrated, and then purpuric lesions recurred on both forearms. This report describes a case of leukocytoclastic vasculitis secondary to rifampin and pyrazinamide therapy.

Section: Introductionmentioning

confidence: 76%

Cutaneous leukocytoclastic vasculitis due to anti-tuberculosis medications, rifampin and pyrazinamide

Moon

Allergy Asthma Immunol Res

et al. 2010

“…Previously, certain types of vasculitis, such as cutaneous leukocytoclastic vasculitis and Henoch-Schönlein purpura, have been reported to be accompanied by TB. [ 11 , 12 ] However, with regard to the relationship between TB and GPA, only 2 case reports are available in which GPA mimicked TB or vice versa. [ 13 , 14 ] Thus, this is the first report to show GPA complicated with TB.…”

Section: Discussionmentioning

confidence: 99%

A case report of granulomatous polyangiitis complicated by tuberculous lymphadenitis

et al. 2018

Rational:Granulomatous polyangiitis (GPA) is a type of vasculitis involving medium and small arteries, typically affecting the upper and lower respiratory tract with coexisting glomerulonephritis. GPA is also characterized by necrotizing granulomatous inflammation and the presence of antineutrophil cytoplasm antibodies (ANCA). So far, various infections have lead to elevation of titers of serum ANCA, making it difficult to diagnose.Patient Concerns:We report a 50-year-old woman who was diagnosed as tuberculous lymphadenitis. During the treatment by anti-tuberculosis (TB) drugs, rapidly progressive renal failure and pleurisy had appeared with elevated titer of PR3-ANCA. Renal biopsy revealed crescentic glomerulonephritis.Diagnosis:Renal biopsy revealed crescentic glomerulonephritis and diagnosis of GPA was made.Interventions:Steroid therapy had been started with continuation of anti-TB drugs.Outcomes:Renal dysfunction had gradually recovered and pleurisy had disappeared with decreasing titer of PR3-ANCA.Lessons:This is the first report of GPA complicated by TB infection. When we encounter a case with rapidly progressive renal failure during the TB infection, complication of GPA should be suspected as 1 of the different diagnosis.

“…Leukocytoclastic vasculitis is an inflammatory syndrome that affects small-sized vessels, and the most prominent histological features are leukocytoclasia (neutrophil fragmentation) and fibrinoid necrosis[8]. It can develop secondary to drugs, infection, collagen disease, or cancer.…”

Section: Introductionmentioning

confidence: 99%

“…It can develop secondary to drugs, infection, collagen disease, or cancer. The most common clinical presentation is a palpable purpura in the lower extremities[8,9], although cutaneous manifestations can also include petechiae, nodules or ulcers. Ultimately, skin biopsy is necessary for diagnostic confirmation[10,11].…”

Section: Introductionmentioning

confidence: 99%

Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

Ferreira

Watanabe

Trevizoli

et al. 2019

WJH

BACKGROUND Infection by the hepatitis C virus (HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver transplantation. CASE SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid necrosis. Liver biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the symptoms. CONCLUSION This case highlights the difficulties of diagnosing skin lesions caused by HCV infection in immunosuppressed patients.