PDF(Pubmed)
Abstract：
A 45-year-old man presented with a diffuse petechial rash and a non-blanching palpable purpura, mainly on his lower extremities, some of which had coalesced, blistered, and ulcerated. The patient had a history of hypercoagulability and was chronically on anticoagulant medication. The rash appeared a week after starting apixaban 5 mg twice daily by mouth. Prior to that, he was receiving rivaroxaban. The rash was biopsied, which demonstrated cutaneous leukocytoclastic vasculitis (LCV). Serum anti-neutrophil cytoplasmic antibody (ANCA) titers were negative. Complement levels of C3, C4, and CH50 were normal. Hepatitis C antibodies were negative. HIV antibodies were non-reactive. Titers for Lyme disease and Rocky Mountain spotted fever were nonreactive. It is unusual for a drug to induce cutaneous LCV with negative ANCA titers. Although rare, it usually requires aggressive therapy. Our case resolved after the discontinuation of apixaban and rivaroxaban and the initiation of warfarin for hypercoagulability in conjunction with a short course of steroids. As the use of apixaban and rivaroxaban increases, we may see a consequent increase in cutaneous LCV that is specifically ANCA-negative.
摘要：
一名45岁的男子出现弥漫性斑点疹和明显的紫癜，主要在他的下肢,其中一些已经合并，起泡，溃烂.患者有高凝病史，长期服用抗凝药物。在开始每天两次口服阿哌沙班5mg后一周出现皮疹。在此之前,他接受了利伐沙班.皮疹做了活检,表现为皮肤白细胞碎裂性血管炎（LCV）。血清抗中性粒细胞胞浆抗体(ANCA)滴度均为阴性。C3、C4和CH50的补体水平正常。丙型肝炎抗体阴性。HIV抗体是非反应性的。莱姆病和落基山斑疹热的滴度无反应。药物诱导具有阴性ANCA滴度的皮肤LCV是不寻常的。虽然罕见，它通常需要积极的治疗。我们的病例在停用阿哌沙班和利伐沙班以及开始使用华法林治疗高凝状态以及短期类固醇后得以解决。随着阿哌沙班和利伐沙班的使用增加，我们可能会看到皮肤LCV随之增加,这是ANCA阴性的。
