Penicillin-induced Cutaneous Necrotizing Eosinophilic Vasculitis with Cryofibrinogenemia

Acta Dermatovenerol Croat. 2019 Mar;27(1):28-32.

Abstract

Cutaneous necrotizing eosinophilic vasculitis (CNEV) is a rare type of vasculitis. Eosinophilic vasculitis is a necrotizing vasculitis with eosinophilic vascular infiltration, in which eosinophils mediate vascular damage in the disease process. We present a case of an 18-year-old girl who developed palpable purpura and hemorrhagic bullae over the lower extremities associated with itching, 7 days after the commencement of penicillin therapy. Plasma cryofibrinogen was positive. Histopathology showed an infiltration of eosinophils within and around the vessel walls and a complete absence of nuclear dust and neutrophils. Oral prednisone at 1 mg/kg induced remission in 2 weeks; the prednisone dose was tapered and discontinued after 2.5 months. There was no evidence of recurrence after 37 months of follow-up. Our patient represents a rare case of drug/penicillin-induced CNEV associated with cryofibrinogenemia, without systemic organ involvement.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / adverse effects*
  • Cryoglobulinemia / complications*
  • Cryoglobulinemia / diagnosis
  • Cryoglobulinemia / therapy
  • Eosinophilia / chemically induced*
  • Eosinophilia / diagnosis
  • Eosinophilia / therapy
  • Female
  • Humans
  • Penicillins / adverse effects*
  • Vasculitis / chemically induced*
  • Vasculitis / diagnosis
  • Vasculitis / therapy

Substances

  • Anti-Bacterial Agents
  • Penicillins

Supplementary concepts

  • Cryofibrinogenemia