Department of Internal Medicine, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia.
Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
J Int Med Res. 2022 May;50(5):3000605221097768. doi: 10.1177/03000605221097768.
Leukocytoclastic vasculitis (hypersensitivity vasculitis) is defined as small blood vessel inflammation with skin or other systemic manifestations due to infections, drugs, or neoplastic disease. This clinical case report highlights an association between ceftriaxone and leukocytoclastic vasculitis in a 49-year-old female patient with a history of penicillin allergy, on mirtazapine for anxiety disorder. Articles concerning antibiotic-induced leukocytoclastic vasculitis are also reviewed. The patient reported a symptom of upper respiratory tract infection and fever 5 days previously for which she received ceftriaxone for 2 days before presenting to the emergency department with a pruritic skin rash in the upper and lower extremities and swollen lips for 1 day. The rash was erythematous, maculopapular, itchy, and non-tender, with no mucus membrane involvement. Laboratory investigations revealed leukocytosis (white blood cells, 22.3 × 10/L) that was mainly eosinophilic (18.4%). The patient was administered prednisolone and antihistamine after stopping ceftriaxone empirically. A skin biopsy confirmed the diagnosis of leukocytoclastic vasculitis. Significant clinical improvement was observed after treatment initiation. Upon follow-up, the skin rash was resolved entirely with no scars; however, there was skin-peeling over the lower extremities. Recognition of antibiotic-induced leukocytoclastic vasculitis is crucial as many classes of antibiotics can contribute to this condition. Continuation of the offending drug may lead to life-threatening complications.
白细胞碎裂性血管炎（超敏性血管炎）定义为由于感染、药物或肿瘤性疾病导致皮肤或其他全身表现的小血管炎症。本临床病例报告强调了 1 例 49 岁女性患者在使用齐拉西酮治疗焦虑症的情况下，使用头孢曲松后出现白细胞碎裂性血管炎的关联，该患者对青霉素过敏。还回顾了与抗生素诱导的白细胞碎裂性血管炎相关的文章。患者报告称，5 天前出现上呼吸道感染和发热症状，此前曾接受头孢曲松治疗 2 天，然后因上、下肢瘙痒性皮疹和嘴唇肿胀 1 天就诊于急诊科。皮疹呈红斑、斑丘疹、瘙痒、非触痛，无黏膜受累。实验室检查显示白细胞增多（白细胞，22.3×10/L），主要为嗜酸性粒细胞（18.4%）。在停用头孢曲松后，患者接受了泼尼松龙和抗组胺治疗。皮肤活检证实了白细胞碎裂性血管炎的诊断。开始治疗后观察到明显的临床改善。随访时，皮疹完全消退，无疤痕；然而，下肢有脱皮现象。识别抗生素诱导的白细胞碎裂性血管炎至关重要，因为许多类别的抗生素都可能导致这种情况。继续使用致病药物可能导致危及生命的并发症。
