Rituximab Induced Vasculitis: Dose the Antigen-Antibody Complex of Rituximab Play a Role in Developing Leukocytoclastic Vasculitis?—A Case Report and Review of the Literature

Rituximab is a monoclonal antibody that targets CD20, which is a specific B-cell surface antigen. It was the first monoclonal antibody that was approved for the treatment of non-Hodgkin lymphoma, rheumatoid arthritis, and other cutaneous lymphoid malignancies. There are many off-label uses of rituximab, such as systemic lupus erythematosus, autoimmune hemolytic anemia, multiple sclerosis, graft-versus-host disease, chronic lymphocytic leukemia, and chronic immune-mediated thrombocytopenia. Among the rare side effects associated with rituximab treatment is vasculitis, more specifically, leukocytoclastic vasculitis. Here, we describe a 21-year-old Saudi female with leukocytoclastic vasculitis occurring three months after treatment with rituximab.

Ulcerative colitis presenting as leukocytoclastic vasculitis of skin

A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

Leukocytoclastic Vasculitis Following Ceftriaxone Exposure

Leukocytoclastic vasculitis (LCV) is an immune-complex mediated inflammation of dermal capillaries and venules that can occur after infections, drugs, autoimmune disorders, neoplasms, or idiopathically. We present the case of a 59-year-old male who was treated with ceftriaxone for an abscess, S. aureus cellulitis, and osteomyelitis of his right second toe. Biopsy confirmed the diagnosis of LCV and symptoms resolved after ceftriaxone was discontinued and systemic corticosteroids were introduced.

An Atypical Cause of Abdominal Pain in an Elderly Patient

Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.

Concentric Centrifugal Figurate Erythema as an Unusual COVID-19 Evanescent Skin Manifestation in a Patient With CD3^(+)/CD45^(+)Lymphocyte Infiltration:A Case Report

Introduction:Coronavirus disease 2019(COVID-19)may be associated with various skin manifestations.Among them,figurate erythema(FE)is rare;only a few clinical reports have been published.Herein,we reported an unusual concentric FE lesions and their immunohistochemical profile in a patient with COVID-19.Case presentation:A 52-year-old woman was diagnosed with COVID-19.One month later,she developed asymptomatic annular erythematous concentric ring lesions on her inner right thigh.The margin of every ring increased in coloration,and the lesions then completely resolved in 2 weeks.A biopsy revealed vasculitis of small vessels,an increase in the fluorescence intensity of CD3 and CD45,and negativity for COVID-19 RNA.Discussion:The results showed an unusual FE that has a clinical mixed type between erythema annulare centrifugum and erythema gyratum repens;the physiopathological mechanism in the FE due to COVID-19 is unknown;one theory involves rapid viral passage into the cutaneous vascular system that triggers an immune and inflammatory response.Although the results exhibited a negative COVID-19 RNA in the tissue,the CD3^(+)/CD45^(+)lymphocyte infiltration could explain the clinical pattern as a direct inflammatory response in the small vessel or as a delayed immune response.Conclusion:Our findings suggest an immunohistochemical small vessel vasculitis pattern with an unusual clinical FE that differs from other types of COVID-19-associated FE or erythema reported previously.