El-Sabbagh Mohamad, Rifai Sarah, Sabah Zainalabedeen M, Tarakji Adam M, Rifai Ahmad O, Dahan Sally, Denig Kristin M
Internal Medicine, Alabama College of Osteopathic Medicine, Dothan, USA.
Nephrology, The Virtual Nephrologist, Panama City Beach, USA.
Cureus. 2023 Aug 30;15(8):e44376. doi: 10.7759/cureus.44376. eCollection 2023 Aug.
A 45-year-old man presented with a diffuse petechial rash and a non-blanching palpable purpura, mainly on his lower extremities, some of which had coalesced, blistered, and ulcerated. The patient had a history of hypercoagulability and was chronically on anticoagulant medication. The rash appeared a week after starting apixaban 5 mg twice daily by mouth. Prior to that, he was receiving rivaroxaban. The rash was biopsied, which demonstrated cutaneous leukocytoclastic vasculitis (LCV). Serum anti-neutrophil cytoplasmic antibody (ANCA) titers were negative. Complement levels of C3, C4, and CH50 were normal. Hepatitis C antibodies were negative. HIV antibodies were non-reactive. Titers for Lyme disease and Rocky Mountain spotted fever were nonreactive. It is unusual for a drug to induce cutaneous LCV with negative ANCA titers. Although rare, it usually requires aggressive therapy. Our case resolved after the discontinuation of apixaban and rivaroxaban and the initiation of warfarin for hypercoagulability in conjunction with a short course of steroids. As the use of apixaban and rivaroxaban increases, we may see a consequent increase in cutaneous LCV that is specifically ANCA-negative.
一名45岁男性出现弥漫性瘀点疹和非压之褪色的可触及性紫癜，主要位于双下肢，部分皮疹已融合、出现水疱并发生溃疡。该患者有高凝病史，长期服用抗凝药物。皮疹在开始口服阿哌沙班5毫克每日两次一周后出现。在此之前，他一直在服用利伐沙班。对皮疹进行活检，结果显示为皮肤白细胞破碎性血管炎（LCV）。血清抗中性粒细胞胞浆抗体（ANCA）滴度为阴性。补体C3、C4和CH50水平正常。丙型肝炎抗体为阴性。HIV抗体无反应。莱姆病和落基山斑疹热的滴度无反应。药物诱导ANCA滴度阴性的皮肤LCV并不常见。虽然罕见，但通常需要积极治疗。我们的病例在停用阿哌沙班和利伐沙班，并开始使用华法林治疗高凝状态并联合短期使用类固醇后得到缓解。随着阿哌沙班和利伐沙班使用的增加，我们可能会看到随之而来的ANCA阴性的皮肤LCV增加。
