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Cefalexin/furosemide Bullous leucocytoclastic vasculitis: case report

A 67-year-old man developed bullous leucocytoclastic vasculitis during treatment with cefalexin and furosemide [routes and dosages not stated; not all indication stated]. The man, who had a history of obesity, hypertension, cerebrovascular accident and gout, presented to hospital with altered mental status, fever and a diffuse blistering rash. Seven days before presentation, he had a painful lesion on his left leg, for which he was prescribed with cefalexin [cephalexin] for presumed cellulitis. Along with this, he also started receiving furosemide. On the day of cefalexin initiation, he developed pink patches on the left foot, shin and calf, and spread to the torso and other extremities. Subsequently, the patches became eroded and blistered. On presentation, he was oriented to self, tachycardic and febrile. Physical examination showed numerous bullae and vesicles over purpuric patches that coalesced over the torso, face and extremities. There was a larger bullae on the bilateral legs and well-circumscribed erosions over the bilateral dorsal feet. Along with, bilateral cheeks had punched-out erosions with the haemorrhagic crust. He had no history of any drug allergies. Laboratory investigations revealed leukocytosis. Flu swab and lumbar puncture for meningitis were negative. A Chest X-ray and CT scan of the brain were unremarkable. The differential diagnosis included bacterial soft tissue infection, disseminated herpes simplex, Stevens-Johnson syndrome, virus/varicella-zoster virus, IgA vasculitis, or another primary autoimmune bullous rash. Punch biopsies were obtained from the arm and back, and histological examination confirmed diagnosis of bullous leukocytoclastic vasculitis with plenty of neutrophils. No viral or other microorganism strains were found. On the day 2, the man started receiving dapsone for an antineutrophil effect. On day 5, he was administered with methylprednisolone because of increased creatinine, haematuria, and persistent altered mental status. Later, a combination of dapsone and steroids was given, and his lesions along with symptoms of altered mental status and acute kidney injury were improved gradually. Methylprednisolone dose was tapered and weaned throughout 10 days. Later, all his medication was stopped on the 22nd day of hospitalisation and no recurrence was noted. Yu Z, et al. A 67-Year-Old Male with Diffuse Purpuric Vesicles and Bullae. Dermatopathology 6: 251-254, No. 4, Aug 2020. Available from: URL: http:// doi.org/10.1159/000503662

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Reactions 3 Oct 2020 No. 1824