The Dark Purple Side of Ceftriaxone: A Case Report on Leucocytoclastic Vasculitis

Authors

• Elia Rigamonti Service of Internal Medicine, Ospedale Regionale di Lugano (Italiano), Ente Ospedaliero Cantonale, Lugano, Switzerland
• Francesca Bedussi Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
• Jerome Blanc Service of Internal Medicine, Ospedale Regionale di Lugano (Italiano), Ente Ospedaliero Cantonale, Lugano, Switzerland
• Pietro Gianella Service of Internal Medicine, Ospedale Regionale di Lugano (Italiano), Ente Ospedaliero Cantonale, Lugano, Switzerland
• Gianluca Vanini Service of Internal Medicine, Ospedale Regionale di Lugano (Italiano), Ente Ospedaliero Cantonale, Lugano, Switzerland

elia.rigamonti@eoc.ch

Keywords

Abstract

We present a case of an 85-year-old woman diagnosed with uncomplicated pyelonephritis, who was treated with intravenous ceftriaxone. Her chronic medications were phenprocoumon, diltiazem and bisoprolol. During the infectious phase, the patient presented tachycardia – despite high-dose beta-blocker treatment – and developed left acute heart failure, with acute renal failure (pre-renal origin). After introduction of furosemide diuretic therapy, clinical conditions improved and better control of the volemic status and heart rate was achieved. Several days after ceftriaxone and digoxin therapy initiation, worsening multiple non-blanching palpable purpuric lesions with bullae and papules, limited to the lower extremities, were noted. Skin biopsy was performed and a diagnosis of leucocytoclastic vasculitis, with associated panniculitis, was made. Ceftriaxone was discontinued and systemic corticosteroids were introduced, with a clear improvement in the cutaneous condition.