Abstract
IntroductionHenoch-Schönlein purpura is a small-vessel systemic vasculitis. Although its exact pathophysiology remains unknown, Henoch-Schönlein purpura has been reported in association with various medical conditions including hypersensitivity. We report the case of a patient with vancomycin-induced Henoch-Schönlein purpura.Case presentationA 42-year-old Caucasian man who had previously undergone a heart transplant was diagnosed as having an intra-abdominal abscess after he underwent a Hartmann procedure. At 15 days after initiation of antibiotic therapy including vancomycin, he developed a purpuric rash of the lower limbs, arthralgia, and macroscopic hematuria. At that time, our patient was already on hemodialysis for end-stage renal disease. Henoch-Schönlein purpura was diagnosed. After a second 15-day course of vancomycin, a second flare of Henoch-Schönlein purpura occurred. Skin biopsies showed leucocytoclastic vasculitis with IgA deposits and eosinophils in the peri-capillary inflammatory infiltrate, suggesting an allergic mechanism. After vancomycin was stopped, we did not observe any further flares. Only five cases of isolated cutaneous vasculitis, one case of lupus-like syndrome and one case of Henoch-Schönlein purpura after vancomycin treatment have been described to date in the literature.ConclusionsClinicians should be aware that systemic vasculitis can be induced by some treatments. Vancomycin is a widely prescribed antibiotic. Occurrence of rare but serious Henoch-Schönlein purpura associated with vancomycin requires its prompt discontinuation.
Highlights
Henoch-Schönlein purpura is a small-vessel systemic vasculitis
Clinicians should be aware that systemic vasculitis can be induced by some treatments
Occurrence of rare but serious Henoch-Schönlein purpura associated with vancomycin requires its prompt discontinuation
Summary
Henoch-Schönlein purpura (HSP) is a small-vessel systemic vasculitis. Its usual clinical presentation includes vascular purpura, abdominal pain, arthralgia, and glomerulonephritis. By day 24 after admission, our patient showed clinical improvement He had no further fever or diarrhea, and his biological test results had normalized, so piperacillin/tazobactam was stopped. A second abdominal CT scan showed an abdominal peri-hepatic abscess, and antibiotic therapy was restarted (piperacillin/tazobactam (4 g twice a day), gentamycin (a single injection), and vancomycin (one injection at each hemodialysis session). Was associated to either other urinary signs, or intra-vesical clotting This new flare was accompanied by systemic inflammatory response syndrome and elevated C-reactive protein level (124 mg/L; normal values < 3 mg/L), and a new empirical antibiotic therapy was initiated, including intravenous gentamycin, ceftriaxone, and valaciclovir. A second skin biopsy was performed on the day the purpura appeared It showed the same leucocytoclastic dermal vasculitis with eosinophils, but vascular IgA and C3 deposits were found with immunofluorescence imaging (Figure 3). After antibiotic therapy was stopped, our patient recovered entirely with disappearance of purpura, arthritis and hematuria, and has not relapsed after a follow-up period of eight months
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