Drug-Induced Leukocytoclastic Vasculitis From an Unreported Source: Daptomycin

Area of Science:

• Dermatology
• Rheumatology
• Infectious Diseases

Background:

• Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis often triggered by medications, infections, or autoimmune conditions.
• Immune complex deposition on dermal capillary endothelial cells causes LCV.
• Common triggers include drugs, infections, autoimmune disorders, and malignancies.

Observation:

• A 58-year-old male developed LCV with painful palpable purpura on lower extremities during treatment for Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis.
• Skin biopsy confirmed LCV.
• Daptomycin and warfarin were discontinued; patient was switched to heparin and ceftaroline.

Findings:

• The patient's LCV was attributed to daptomycin, marking the first reported case of daptomycin-induced LCV.
• MRSA-induced LCV and warfarin-induced skin necrosis (WISN) were ruled out through clinical and histopathological evaluation.
• Discontinuation of daptomycin and supportive care led to LCV resolution.

Implications:

• This case highlights daptomycin as a potential cause of LCV.
• Emphasizes the importance of considering drug-induced vasculitis in differential diagnosis.
• Underscores the need for prompt recognition and management of drug reactions for favorable outcomes.