Rifamycin induced leukocytoclastic vasculitis. A rare side-effect of anti-tuberculous chemotherapy

We describe a case of leucocytoclastic vasculitis (LCV) caused by rifamycins.A 53 year old female presented with cough, night sweats and upper lobe nodules. Bronchial-alveolar lavage confirmed fully sensitive mycobacterium tuberculosis (TB).She commenced treatment with rifampicin, isoniazid, ethambutol and pyrizinazmide. At 4 weeks she developed an extensive purpuric rash, malaise and joint aches. There was no evidence of other infections or connective tissue disorders on extensive screening. Her inflammatory markers were elevated. A punch biopsy of her shin demonstrated leukocytoclastic vasculitis of the superficial dermis. All TB medications were discontinuted and she started oral steroids. The rash resolved within 2 weeks.She started Moxifloxacin, Isoniazid and Ethambutol without complication. After 1 week Rifabutin was introduced. This led to recurrence of the rash. Rifabutin was stopped; the rash resolved and inflammatory markers normalised. She continues on an 18 month course of Moxifloxacin, Isoniazid and Ethambutol.Leukocytoclastic vasculitis (LCV) is a hypersensitivity vasculitis characterised by small vessel damage by nuclear debris from invading neutrophils. It typically affects the skin and joints and can be precipitated by medications and infections2.This case illustrates that clinicians should be aware LCV is a rare side affect of Rifamycins.1. Kim JH et al. Allergy Asthma Immunol Res. 2010 Jan; 2(1): 55–58.2. Brooke A et al. Medscape Drugs and Diseases.

Source: European Respiratory Journal - November 7, 2016 Category: Respiratory Medicine Authors: Ewence, A., Dodd, J., Tewari, A., Akhras, V., Aul, R. Tags: 10.2 Tuberculosis Source Type: research