Leucocytoclastic vasculitis as a late complication of clopidogrel therapy

Abstract

We describe a case of leucocytoclastic vasculitis manifested as exanthematous rash in a 57-year-old woman on long-term therapy with clopidogrel. The diagnosis was confirmed by skin biopsy. The patient was managed symptomatically with oral antihistaminics and topical steroids in consultation with dermatologists. Clopidogrel therapy was discontinued on suspicion of drug-induced vasculitis. The rash resolved completely within 2 weeks of withdrawal of clopidogrel, satisfying criteria for a probable adverse drug reaction. Leucocytoclastic vasculitis is an unusual adverse effect of clopidogrel therapy and even rarer as a late complication.

Small-Vessel Vasculitis After ST-Segment Elevation Myocardial Infarction

“…In 1 case, the onset of CSVV was 4 days after the introduction of clopidogrel 8 and in the other, it was as long as 1 year. 9 Complete resolution of CSVV took 7 days and 14 days, respectively, which is comparable to our case.…”

“…Clopidogrel is a very rare cause of CSVV, which, to the best of our knowledge, has been previously reported in only 2 cases ( Table 1 , cases 6 8 and 7 9 ). In 1 case, the onset of CSVV was 4 days after the introduction of clopidogrel 8 and in the other, it was as long as 1 year.…”

Hypersensitivity reactions to modern antiplatelet and anticoagulant drugs

“…A number of cases of hypersensitivity syndromes involving pancytopenia or neutropenia and/or hepatitis and generalized, partially vesiculous maculopapular exanthem and febrile state while using clopidogrel have been described [ 10 , 11 ]. Isolated cases of serum sickness-like disease [ 12 ], suberythrodermic pustular psoriasis [ 13 ], acute generalized exanthematous pustulosis (AGEP) [ 14 ] and leukocytoclastic vasculitis [ 15 , 16 ] are known – often with good tolerance of prasugrel, which generally appears to elicit fewer hypersensitivity reactions. Prasugrel is known to have caused immediate-type allergic reactions involving urticaria, pruritus, angioedema and dyspnea, as well as one case of hepatitis with pyrexia [ 17 ].…”