Abstract

PUNCHING FOR THE TRUTH BENEATH THE RASH: A CASE OF WARFARIN-INDUCED LEUKOCYTOCLASTIC VASCULITIS

Mary Joahn Rodriguez-Malave MD MPH*, Jose I. Ruiz-Rodriguez MD, Carla Colon- Nuñez MD, Viviana Blanco-Rivera MD and Vanessa Sepulveda-Rivera MD MSc

Abstract

Warfarin is a commonly used anticoagulant. It is associated with many adverse effects, including major or minor bleedings, purple toe syndrome, and cutaneous manifestations. Although rare, leukocytoclastic vasculitis (LCV) has been reported in the literature. We present the case of a 65-year old male patient who presented with palpable purpura and acute kidney injury with proteinuria five weeks after starting warfarin for an acute lower extremity deep venous thrombosis. A punch biopsy of the lesions revealed leukocytoclastic vasculitis. Renal biopsy showed findings suggestive of pauci-immune glomerulonephritis. The offending agent was discontinued, and intravenous methylprednisolone was given with complete resolution of skin eruptions and renal failure. The patient was discharged home on apixaban without recurrence of the rash. Early recognition, prompt diagnosis and management will prevent morbidity and mortality in people at risk.

Keywords: Leukocytoclastic vasculitis, warfarin, hematuria, acute renal failure, glomerulonephritis.