Type III hypersensitivity to insulin leading to leukocytoclastic vasculitis

Abstract

Here, we report the occurrence of leukocytoclastic vasculitis as an outcome of type III allergy to insulin in a patient with type II diabetes mellitus. The diagnosis was made on the basis of anatomo-pathological examination of a skin biopsy.

Ambulatory intravenous insulin and islet cell transplantation to treat severe type III insulin hypersensitivity in a patient with type 1 diabetes mellitus

“…Desensitization, though efficacious for IgE mediated, immediate type-1 hypersensitivity (T1HS), 3,5 has been noted to be unsuccessful in other cases of T3HS. 5,6 Oral prednisolone doses up to 40 mg daily 5 have been reported as efficacious, but the use is typically described in conjunction with other interventions, such as insulin cessation, 7 change, or use of an alternate immunosuppressant. 5 Our patient received a relatively low prednisolone dose (10 mg daily), which may explain the absence of response to glucocorticoids.…”

Type III Hypersensitivity Reaction to Subcutaneous Insulin Preparations in a Type 1 Diabetic

“…9 If avoidance of insulin is not an option and an alternative non-reactive formulation cannot be identified, therapy should be directed at immunosuppression. While previous cases have found insulin-induced LCV to be responsive to systemic glucocorticoids, 3,5 these medications are best used to transition to other immunosuppressants because of their long-term side effects. In our particular case, it took several weeks of immunosuppression with 6-MP and colchicine before our patient was able to tolerate any insulin preparation.…”

“…Although not necessary in our case, the use of direct immunofluorescence can be helpful in identifying these complexes. 3 Alternate therapeutic options to immunosuppression for insulin-dependent diabetics with insulin hypersensitivity are quite limited. Pancreas transplantation would theoretically eliminate the need for subcutaneous insulin; however, this entails significant surgical risks and long-term immunosuppression that must be considered.…”

“…As such, it is important for physicians to recognize insulin hypersensitivity early and respond accordingly. Reported cases of type III hypersensitivity reactions to insulin have generally been limited to particular formulations of insulin such as insulin detemir, insulin aspart, or NPH insulin, [1][2][3] associated with a blood dyscrasia, 4 or included an element of type I hypersensitivity. 5 We describe the case of a type I diabetic with common variable immunodeficiency (CVID) and autoimmune enteropathy who presented to the hospital with DKA secondary to a type III hypersensitivity reaction to all available forms of subcutaneous insulin and share a successful management strategy.…”

Staphylococcus aureus Bacteremia Masquerading as Leukocytoclastic Vasculitis

“…Pathologically, the result is a type III hypersensitivity reaction where antigen-antibody immune complexes are deposited in postcapillary venules, leading to complement activation and neutrophil chemotaxis. 3,7,8 Local vessel destruction leads to red blood cell leak and an inflammatory infiltrate in the interstitium, making the purpura palpable. 9 Both infectious and host factors have been proposed in the pathogenesis of bacterial-induced leukocytoclastic vasculitis, including direct toxin effects on vessels, invasion and occlusion of blood vessel walls by microorganisms, distant embolism, and hypersensitivity reaction with immune complex deposition.…”