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Case Reports
. 2023 Mar 1;17(1):143-147.
doi: 10.1159/000529045. eCollection 2023 Jan-Dec.

Leukocytoclastic Vasculitis Associated with Adalimumab Therapy for Crohn's Disease

Lankai Cathy Xu  1 , Sirisha Grandhe  2 , Joseph G Marsano  2
Affiliations
Case Reports

Leukocytoclastic Vasculitis Associated with Adalimumab Therapy for Crohn's Disease

Lankai Cathy Xu et al. Case Rep Gastroenterol. .

Abstract

Leukocytoclastic vasculitis (LCV) is rarely associated with anti-tumor necrosis factor [TNF] α therapy. We report a 22-year-old man with new onset of a pustular rash on his bilateral upper and lower extremities while on adalimumab therapy for Crohn's disease. Skin biopsy of the affected area showed perivascular extravasation of erythrocytes, neutrophils, eosinophils and vascular damage surrounding blood vessels associated with fibrin, consistent with LCV. Patient was treated with topical steroids and subsequently transitioned to ustekinumab therapy with follow-up colonoscopy showing minimal active disease. Our report highlights the association of a unique dermatologic autoimmune manifestation with TNF-targeted therapy in a patient with Crohn's disease.

Keywords: Adalimumab; Case report; Crohn’s disease; Leukocytoclastic vasculitis.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Initial presentation of pustular rash on hands and lower extremities approximately 1 year after initiating adalimumab.
Fig. 2.
Fig. 2.
Pathology of skin biopsy sections shows perivascular extravasation of erythrocytes, neutrophils, eosinophils as well as leukocytoclasis (vascular damage) surrounding blood vessels associated with fibrin. These findings are consistent with LCV. H&E stain, ×10 magnification.
Fig. 3.
Fig. 3.
Improvement in LCV 3 months after cessation of adalimumab and treatment with doxycycline and topical clobetasol.
See this image and copyright information in PMC

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