Nafcillin implicated in a case of cutaneous and gastrointestinal leukocytoclastic vasculitis

Abstract

Leukocytoclastic vasculitis (LV) is a rare hypersensitive reaction involving the small vessels, which is usually mediated by drugs. Very few cases of nafcillin -associated LV have been reported. Here, we reported a case of LV with the presentation of skin rashes and gastrointestinal bleeding after receiving nafcillin, evidenced by endoscopy and skin biopsy. The symptoms resolved after withdrawal of nafcillin and the addition of prednisone treatment. LV should be considered in the differential diagnosis of erythematous rash, especially with gastrointestinal symptoms after the exposure.

Keywords: Biopsy; Endoscopy; Gastrointestinal; Hypersensitive.

[Table/Fig-1]:

Nonpalpable non-pruritic palpable petechia eruption

[Table/Fig-2]:

Endoscopy showed multiple ulcers scattered throughout 2nd and 3rd parts of duodenum consistent with vasculitis before treatment (upper) and healed ulcers after treatment (lower) (From GI lab of Vidant Medical Center)

[Table/Fig-3]:

Skin biopsy revealed perivascular and eosinophil infiltrates and tissue swelling consistent with leukocytoclastic vasculitis. There was fibrin deposition and vessel wall damage. (From Path lab of Vidant Medical Center)