Drug-Induced Leukocytoclastic Vasculitis From an Unreported Source: Daptomycin

Leukocytoclastic vasculitis (LCV) is a rare small-vessel vasculitis caused by immune-complex-mediated deposition on endothelial cells of dermal capillaries. Common triggers include medications, infections, autoimmune disorders, and malignancies. We present a case of a 58-year-old male who developed daptomycin-induced LCV after being treated for Methicillin-resistant Staphylococcus aureus (MRSA) endocarditis. The patient experienced painful palpable purpura on his lower extremities, which was diagnosed as LCV by skin biopsy. At the time of the biopsy, warfarin and daptomycin were discontinued, and the patient was transitioned to heparin and ceftaroline. MRSA-induced LCV was ruled out, due to negative blood cultures and adequate source control of his infection at the time of development of the skin lesions. Warfarin-induced skin necrosis (WISN) was ruled out based on histopathological findings. This case is clinically significant as it represents the first reported case of LCV associated with daptomycin use. It underscores the importance of considering the patient's history, clinical presentation, and histopathological findings to ensure prompt recognition and management of this rare drug reaction, allowing for the resolution of LCV.