Allergy Asthma Immunol Res.  2010 Jan;2(1):55-58. 10.4168/aair.2010.2.1.55.

Cutaneous leukocytoclastic vasculitis due to anti-tuberculosis medications, rifampin and pyrazinamide

• Kim JH
• Moon JI
• Kim JE
• Choi GS
• Park HS
• Ye YM
• Yim H

• KMID: 2260420
• DOI: http://doi.org/10.4168/aair.2010.2.1.55

Abstract

Anti-tuberculosis drugs frequently result in cutaneous adverse reactions, including pruritus, maculopapular exanthems, and urticaria. However, anti-tuberculosis drug-associated cutaneous leukocytoclastic vasculitis (CLV) has been rarely reported. We describe a case of CLV induced by rifampin and pyrazinamide. A 38-year-old male had been diagnosed with pulmonary tuberculosis two months ago and then he started standard anti-tuberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide. Purpuric lesions developed in the extremities after 1.5 months of anti-tuberculosis medication; the lesions progressively spread over the entire body. Histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after cessation of anti-tuberculosis medications and treatment with oral corticosteroids and antihistamines. Anti-tuberculosis drugs were rechallenged one at a time over 3 days. Purpura recurred on the right forearm and forehead after taking 300 mg of rifampin. The skin lesion disappeared after taking oral prednisolone. Finally, 1,500 mg of pyrazinamide was readministrated, and then purpuric lesions recurred on both forearms. This report describes a case of leukocytoclastic vasculitis secondary to rifampin and pyrazinamide therapy.

Keyword

Cutaneous leukocytoclastic vasculitis; rifampin; pyrazinamide; pulmonary tuberculosis

MeSH Terms

Adrenal Cortex Hormones
Adult
Ethambutol
Exanthema
Extremities
Forearm
Forehead
Histamine Antagonists
Humans
Isoniazid
Male
Prednisolone
Pruritus
Purpura
Pyrazinamide
Rifampin
Skin
Tuberculosis, Pulmonary
Urticaria
Vasculitis
Vasculitis, Leukocytoclastic, Cutaneous
Adrenal Cortex Hormones
Ethambutol
Histamine Antagonists
Isoniazid
Prednisolone
Pyrazinamide
Rifampin
Vasculitis, Leukocytoclastic, Cutaneous

Figure

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  Fig. 1 Palpable purpura and ulcerations developed on the upper and lower extremities of a patient undergoing rifampin and pyrazinamide therapy.

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  Fig. 2 Biopsy of skin lesions: dermal small vessels show fibrinoid change, perivascular neutrophilic and eosinophilic infiltrate and nuclear debris. This is consistent with the characteristic feature of leukocytoclastic vasculitis.

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