Korean J Transplant.  2023 Nov;37(Suppl 1):S134. 10.4285/ATW2023.F-7182.

Leukocytoclastic vasculitis in transplant recipients

• Primula F
• Hasiholan Marbun MB

• KMID: 2551754
• DOI: http://doi.org/10.4285/ATW2023.F-7182

Abstract

Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis that usually occurs on the skin but can also cause systemic small vessel disease. Pathogenesis of LCV involves the formation of immune complexes that deposit in small vessels and cause damage. We report a 53-year-old man who underwent a kidney transplant at the Kidney Transplant Center, Cipto Mangunkusumo Hospital, Jakarta. He had hypertension since 10 years ago and chronic kidney disease underwent hemodialysis since 1 year ago. He underwent a kidney transplant February 2023 with an unrelated donor and the same blood type. After the transplant he was on treatment with tacrolimus XL 8 mg once-daily, mycophenolate mofetil 500 mg twice-daily and methylprednisolone 16 mg once-daily. Two weeks after the kidney transplant, the patient complained of petechiae appears on the legs and kidney function began to decline. Laboratory tests showed levels of urea 128 mg/dL, creatinine 2.6, tacrolimus 13.6 ng/mL. The patient underwent a skin biopsy on the thigh and right leg, the histological results showed more support for LCV. In further treatment, kidney function progressively decreased and diagnosed as acute rejection, then it was decided to perform a nephrectomy, but the patient refused and the patient died due to sepsis. The most common cause of LCV is drugs although infection, malignancy, and connective tissue disease can also occur. Although the relationship between tacrolimus and LCV is lacking in the literature, such an association has been reported in a US Food and Drug Administration study report. In this patient, the cause of LCV cannot be proven due to tacrolimus administration or other causes, where this patient also suffers from a pneumonia infection which might also exacerbate LCV. It is critical for us to recognize and effectively manage LCV to prevent morbidity and mortality.