Tenofovir-induced Leukocytoclastic Vasculitis

Abstract

Tenofovir, a nucleotide analog, is one of the first-line medications recommended for the treatment of active chronic hepatitis B virus infection (CHB) and as a primary prophylaxis to prevent hepatitis B reactivation in cases of immunosuppression. We report the first case of tenofovir-induced leukocytoclastic vasculitis (LCV). A 43-year-old obese woman, who was known to have inactive CHB, was diagnosed with chronic immune thrombocytopenic purpura (ITP). She was treated with corticosteroid therapy and was put on tenofovir to prevent hepatitis B virus reactivation. A month later, she developed a skin rash, described as non-blanchable well-defined erythematous to violaceous papules and targetoid patches in her lower extremities. A skin biopsy showed features of LCV. The rash resolved completely within few days after replacing tenofovir with entecavir.

Keywords: Hepatitis B; Leukocytoclastic Vasculitis; Tenofovir.

Figure 1

Hematoxylin and eosin stained skin biopsy showing epidermis and dermis with periadnexal and interstitial inflammatory cell infiltrate (red arrows), magnification = 5 ×.

Figure 2

Hematoxylin and eosin stained skin biopsy showing mixed dermal infiltrate consisting predominantly of neutrophils (red arrow), admixed with eosinophils (yellow arrow), and lymphocytes (blue arrow), magnification = 40 ×.