Leukocytoclastic Vasculitis

Abstract

Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus among other acute febrile illnesses present with prodromal symptoms of fever, malaise, myalgia, anorexia followed by a distinct maculopapular rash, hepatosplenomegaly, and lymphadenopathy. In this case report, we present a patient who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil Felix test, a diagnostic titer of 1:640 against OX-K was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with Doxycycline and showed a drastic improvement in his symptoms.
 Keywords: Scrub Typhus, Rickettsia; Vasculitis; Doxycycline.

Re: Leukocytoclastic Vasculitis

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We read with interest the recent report of Vasireddy A et al about 10 leukocytoclastic vasculitis (LV) associated with a Scrub typhus infection affecting a 28-11 year-old male, who presented with multiple, palpable purpuric eruptions mainly on the 12 lower extremities. 1 The routine laboratory determinations were unremarkable, and blood 13 confirmation of LV, 68.4% males, median age of 48.4 (13-93) years; 3 patients had 34 diagnosis of IgA vasculitis, 5 had diagnosis of urticarial vasculitis, and the 11 others 35 were considered as LV. Palpable purpura (with or without necrosis and hemorrhagic 36 blistering) was the predominant manifestation; and the commonest affected areas were 37 the lower limbs and the trunk.

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“…about leukocytoclastic vasculitis (LV) associated with a Scrub typhus infection affecting a 28-year-old male, who presented with multiple, palpable purpuric eruptions mainly on the lower extremities. 1 The routine laboratory determinations were unremarkable and blood specific tests for autoimmune disorders, as well as malaria and bacterial and viral infections were negative; except for the Weil Felix test that was positive with a titre over 1:640 against OXK. Biopsy study of skin lesion showed the dermis with vasculo-centric infiltrate, and vessel walls with fibrinoid necrosis and dense infiltration by neutrophils, and leukocytoclasis.…”

“…Undergoing antimicrobial schedule of doxycycline, the patient improved in three weeks. 1 In fact, the authors emphasised the major infectious causes of leukocytoclastic vasculitis; but in the current global scenario one could include COVID-19 among the aetiologies. 2 – 5 …”