Priessnitz Jennifer K, Kuzel Timothy, Ackerman Lindsay, Nicolasora Nelson
Internal Medicine, Joan and Macon Brock Virginia Health Sciences, Old Dominion University, Norfolk, USA.
Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Cureus. 2025 Apr 18;17(4):e82490. doi: 10.7759/cureus.82490. eCollection 2025 Apr.
Leukocytoclastic vasculitis (LCV) is a rare small-vessel vasculitis caused by immune-complex-mediated deposition on endothelial cells of dermal capillaries. Common triggers include medications, infections, autoimmune disorders, and malignancies. We present a case of a 58-year-old male who developed daptomycin-induced LCV after being treated for Methicillinresistant (MRSA) endocarditis. The patient experienced painful palpable purpura on his lower extremities, which was diagnosed as LCV by skin biopsy. At the time of the biopsy, warfarin and daptomycin were discontinued, and the patient was transitioned to heparin and ceftaroline. MRSA-induced LCV was ruled out, due to negative blood cultures and adequate source control of his infection at the time of development of the skin lesions. Warfarin-induced skin necrosis (WISN) was ruled out based on histopathological findings. This case is clinically significant as it represents the first reported case of LCV associated with daptomycin use. It underscores the importance of considering the patient's history, clinical presentation, and histopathological findings to ensure prompt recognition and management of this rare drug reaction, allowing for the resolution of LCV.
白细胞破碎性血管炎（LCV）是一种罕见的小血管炎，由免疫复合物介导沉积于真皮毛细血管内皮细胞所致。常见诱因包括药物、感染、自身免疫性疾病和恶性肿瘤。我们报告一例58岁男性患者，其在接受耐甲氧西林金黄色葡萄球菌（MRSA）心内膜炎治疗后发生了达托霉素诱导的LCV。患者下肢出现疼痛性可触及紫癜，经皮肤活检诊断为LCV。活检时停用了华法林和达托霉素，患者改用肝素和头孢洛林。由于血培养阴性且在皮肤病变出现时对其感染进行了充分的源头控制，排除了MRSA诱导的LCV。根据组织病理学结果排除了华法林诱导的皮肤坏死（WISN）。该病例具有临床意义，因为它是首例报道的与使用达托霉素相关的LCV病例。它强调了考虑患者病史、临床表现和组织病理学结果以确保及时识别和处理这种罕见药物反应的重要性，从而使LCV得以缓解。
