Leukocytoclastic vasculitis complicating adalimumab therapy for Crohn's disease: Report of three cases

Bernardes, Carlos; Carvalho, Diana; Saiote, Joana; Ramos, Jaime

doi:10.1016/j.gastrohep.2017.08.004

Cited by 12 publications

(5 citation statements)

References 7 publications

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“…Levofloxacin as the cause of LCV in our case seemed unlikely given the presence of lesions prior to its administration. Ustekinumab was recently reported as a cause of vasculitis [ 21 ], adding it to the list of monoclonal antibodies implicated in LCV [ 11 , 15 , 16 , 19 , 20 ]. We considered ustekinumab as an etiology in this case, yet it seemed less likely when our patient tolerated re-initiation and long-term continuation of this medication without worsening of her LCV.…”

Section: Discussionmentioning

confidence: 99%

“…LCV responds well to steroid therapy and resolves quickly without scarring in most cases reported. Namakura [ 15 ] and colleagues reported a case of spontaneous resolution; Bernardes [ 16 ] reported 3 cases resolving without steroid therapy after withdrawal of adalimumab, and one case reported steroid-resistant LCV which resolved with colchicine [ 19 ]. While the rash subsides within days in the majority of cases, longer time to resolution has been reported [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

et al. 2020

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Background Leukocytoclastic vasculitis (LCV) is an immune-complex mediated vasculitis characterized by neutrophilic inflammation and nuclear debris in post capillary venules. LCV is a rare dermatologic manifestation of Crohn’s disease (CD) and may occur with the onset of the disease or any time after the diagnosis including the period of exacerbation. Case presentation We present a 70 year old woman with history of psoriasis and treatment refractory CD requiring monoclonal antibody therapy with ustekinumab. One month prior to the current admission, she developed abdominal pain, worsening diarrhea and was diagnosed with CD exacerbation for which she was given ustekinumab. While her abdominal symptoms mildly improved with ustekinumab, she developed new bilateral lower extremity rash initially treated with levofloxacin for presumed cellulitis. The rash consisted of mild erythematous, non-scaling patches with scattered non-palpable petechiae on the lower extremities with subsequent involvement of abdomen, lower back and buttocks. Abdominal exam showed diffuse tenderness without mass, guarding or rebound while reminder of physical exam was unremarkable. Following the failure of antimicrobial therapy, she was diagnosed with LCV by skin biopsy. Complete work up was negative for infectious, malignant and inflammatory etiologies of LCV. Patient improved with increased dose of budesonide and subsequently continued to tolerate ustekinumab without recurrence of LCV. Discussion and conclusion LCV is a rare form of vasculitis and one of the rarest dermatologic manifestations of CD, appearing at any stage of the disease. LCV has been associated with autoimmune diseases, infections, specific drugs (levofloxacin, ustekinumab), and malignancy. Clinical presentation of LCV is variable and frequently mistaken for cellulitis. LCV should be considered in differential diagnosis of bilateral lower extremity rash in patients with CD after infectious, malignant and auto-immune/inflammatory etiologies are excluded. Unlike erythema nodosum (EN) and pyoderma gangrenosum (PG), LCV requires biopsy for diagnosis. Most patients respond well to steroids without scarring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

et al. 2020

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“…Vasculitis in IBD patients remains a rare and, fortunately, mild complication for most patients, and it mainly relates to the drugs used to treat IBD [29][30][31]. In a retrospective review of the patients evaluated at the Mayo Clinic from January 1998 to March 2011, only eight patients with vasculitis associated with anti-TNF therapy were identified, and, of these, only four had IBD [3].…”

Section: Discussionmentioning

confidence: 99%

Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study

Parra

Chebli

et al. 2023

JCM

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Background: Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients. Methods: Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy. Results: There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn’s disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4–12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months). Conclusions: LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.

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“…Only a few cases of anti-TNF-induced vasculitis have been related to inflammatory bowel disease [ 17 , 18 , 19 , 20 , 21 , 22 ]. Unfortunately, no guidelines are available for the management of this condition.…”

Section: Discussionmentioning

confidence: 99%

Anti-TNF-Related Leukocytoclastic Vasculitis in Ulcerative Colitis: A Case Report

Giorgio

Blasi

Rigante

et al. 2021

IJERPH

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Background: The development of drugs directed against tumor necrosis factor (TNF)-α has dramatically modified the therapeutic approach to inflammatory bowel diseases: a larger use of such drugs has also led to a major knowledge about their adverse effects, especially on skin. The aim of this report was to describe a rare steroid-dependent form of leukocytoclastic vasculitis induced by an anti-TNF-α agent in a young woman with ulcerative colitis. Case presentation: A young girl with ulcerative colitis developed a form of leukocytoclastic vasculitis induced by an anti-TNF-α agent. Recurrent palpable purpuric lesions on her legs were the main cutaneous manifestation. Skin lesions were steroid-dependent, but improved after withdrawal of the anti-TNF-α agent and second-line immunosuppressant therapy. Conclusions: The need to develop specific recommendations to guide the use of medications for managing skin reactions induced by anti-TNF-α drugs is herein emphasized.

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Leukocytoclastic vasculitis complicating adalimumab therapy for Crohn's disease: Report of three cases

Cited by 12 publications

References 7 publications

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report

Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study

Anti-TNF-Related Leukocytoclastic Vasculitis in Ulcerative Colitis: A Case Report

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