Abstract | May 6, 2021
Trimethoprim/Sulfamethixazole Induced Cutaneous Leukocytoclastic Vasculitis
Learning Objectives
- To inform readers about different medications that can indice vasculitis.
Background:
Leukocytoclastic vasculitis is a type of vasculitis that involves small blood vessels in which the inflammatory deposition is composed of neutrophils predominantly. Multiple medications are reported as a cause of cutaneous leukocytoclastic vasculitis. In this case, we discuss a 68-year-old Caucasian female with an interesting presentation of leukocytoclastic vasculitis.
Case:
The patient is a 68 year old Caucasian female with a past medical history of CAD and HFrEF who presents to the hospital for multiple falls. The patient was recently discharged for amputation with superimposed cellulitis. Bactrim was started at the end of her previous hospitalization, 1 week prior to the current hospitalization. 3-4 days after initiation of antibiotics, dark red spots were noticed on her legs. Labs were ordered which consisted of ESR, CRP, cryoglobulins, acute hepatitis panel, HIV, ANCA panel, ANA panel, C3, C4, and immunoglobulins. ESR was noted to be greater than 140 and CRP was noted to be 2.3. A skin punch biopsy was performed and revealed perivascular infiltrate predominantly in the superficial blood vessels composed of lymphocytes and neutrophils coinciding with cutaneous leukocytoclastic vasculitis.
Decision‐making:
The decision to provide therapeutic steroids versus holding the causative agent being Trimethoprim/Sulfamethoxazole is very keen in this case. Providing steroids to the patient who recently underwent an amputation and had a superimposed cellulitis could exacerbate the infection and potentiate worsening symptoms for the patient. Overall, it was concluded that holding the antibiotic was the best treatment.
Conclusion:
The typical histopathologic feature of cutaneous vasculitis is the presence of vasculitis of small vessels, postcapillary venules are the most commonly involved. This vasculitis is characterized by a leukocytoclasis. Lesions most commonly occur in the lower extremities. A mild leukocytosis with or without eosinophilia is characteristic, as is an elevated ESR. Cutaneous vasculitis is diagnosed by demonstration of vasculitis on a biopsy. In patients with cutaneous vasculitis it is important to search for the etiology of the vasculitis.
