SHM Converge Scientific Abstract ePoster Gallery-Leukocytoclastic Vasculitis as an Unexpected Complication of Apixaban

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A 71-year-old woman was hospitalized for MSSA bacteremia and treated with cefazolin. Two weeks later, she was readmitted for tachycardia, and evaluation revealed splenic vein thrombosis. She was started on apixaban. Within two days, she developed generalized pruritus and a rapidly progressive non-blanching palpable purpuric rash involving the lower back, thighs, calves, upper extremities, and face.<br /><br />An extensive workup for infectious, malignant, and connective tissue causes was negative. Because she had already tolerated cefazolin for two weeks before the rash appeared, cefazolin was considered less likely to be the cause. Apixaban was stopped, and a skin punch biopsy showed early leukocytoclastic vasculitis (LCV). Her skin lesions improved dramatically within three days of stopping apixaban, without additional treatment. She was later switched to rivaroxaban without recurrence.<br /><br />The case highlights apixaban as a rare but important cause of LCV, a small-vessel immune-mediated vasculitis that commonly presents with palpable purpura. Reported cases of apixaban-associated LCV are few, with rash onset typically occurring 7 to 21 days after exposure. This report emphasizes the need for clinicians to consider apixaban-induced vasculitis in patients who develop new purpura after starting the drug, since early recognition and discontinuation can lead to rapid resolution and prevent further morbidity.

Asset Subtitle

Oksana Petrechko

Meta Tag

Author List Eva Angeli, Oksana Petrechko, Sarah Kessler

Category Clinical Vignettes

Concept Leukocytoclastic Vasculitis

Concept Apixaban

Concept Palpable Purpura

Concept Skin Punch Biopsy

Concept Purpura

Distinguished Non-Finalist

Presenter Organization University of New Mexico School of Medicine

Presenting Author Oksana Petrechko

Track Adult

Keywords

apixaban

leukocytoclastic vasculitis

palpable purpura

drug-induced vasculitis

MSSA bacteremia

cefazolin

splenic vein thrombosis

pruritus

skin biopsy

rivaroxaban

Leukocytoclastic Vasculitis

Apixaban

Palpable Purpura

Skin Punch Biopsy

Purpura