An Unusual Timing of Amoxicillin-Induced IgA Vasculitis in an Elderly Patient

Emmanuel Fohle,Joseph Murat,Tze Shien Lo,Rachel Ness,Sean Montgomery

doi:10.7759/cureus.15757

Emmanuel Fohle, Joseph Murat + Show 3 more

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https://doi.org/10.7759/cureus.15757

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Abstract

Immunoglobulin A vasculitis is a small vessel vasculitis which is usually common in the pediatric group. It is rare in adult population but more severe than in children. Proposed triggers include infections, malignancy and medications. For most part, the association is made when immunoglobulin A vasculitis develops within two weeks after starting the implicated medication. A 66-year-old male who was treated with amoxicillin/clavulanate for presumed right fourth toe infection but returned to the emergency department 48 hours later with palpable purpura of lower limbs, arthralgia with swollen hands and colicky abdominal pain with nausea. Abdominal computed tomography (CT) scan showed mildly dilated small bowel. Skin biopsies showed leukocytoclastic vasculitis with IgA deposit on immunofluorescence. The patient was treated with a short course of steroid and the rash was significantly reduced during subsequent follow-up. Although amoxicillin/clavulanate is widely prescribed, clinicians need to be aware of this risk and immediately stop it if signs of drug-induced vasculitis develop.

Highlights

Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura (HSP), is a systemic vasculitis that primarily involves small vessels
A 66-year-old male who was treated with amoxicillin/clavulanate for presumed right fourth toe infection but returned to the emergency department 48 hours later with palpable purpura of lower limbs, arthralgia with swollen hands and colicky abdominal pain with nausea
Malignancy and medications which for most part the association is made when IgA vasculitis develops within two weeks after starting the implicated medication [4]

Summary

Introduction

Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura (HSP), is a systemic vasculitis that primarily involves small vessels. A 66-year-old male with medical history of chronic kidney disease (CKD) stage III, type II diabetes complicated with diabetic neuropathy status post-right 5th toe amputation few years ago presented to the emergency department with discharge from the 4th toe ulcer He developed symptoms of a pruritic rash involving the limbs, arthralgia, and severe diffuse abdominal pain associated with nausea and vomiting 48 hours after starting oral amoxicillin/clavulanate. There was symmetric distribution of palpable purpura (Figure 1, Panels A-C) involving both lower extremities with 3mm ulcer on dorsal surface of the 4th right toe but no erythema His hands were swollen and had limited range of motion. During subsequent follow-up, his rash significantly receded and the swelling of his hands resolved (Figure 1, Panels D-F)

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Ebert EC