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Patient Case
This patient presented with bilateral lower extremities, specifically on the shins and knees, with the onset of multiple tender ulcerative lesions (1-2cm) that began a few weeks prior while hiking in Germany, Denmark, and Norway. Despite being cautious about tick bites and having minimal animal contact, the lesions expanded, becoming more ulcerative, erythematous, and painful until admission back in the US. The patient has a past medical history of Crohn’s disease managed with 6MP and adalimumab without recent flares for approximately 13 years.
The challenge presented is the unclear underlying cause of the leukocytoclastic vasculitis (LCV) revealed through a biopsy, despite initial presumptions of erythema nodosum and treatment attempts with amoxicillin, clindamycin, and steroids while in Germany.
Feedback offered to the challenge includes the need for further investigation and consideration of other potential triggers beyond the initial presumptions. One feedback suggests, “Further investigation needed to determine underlying cause of LCV,” while another emphasizes, “Consideration of other potential triggers beyond initial presumptions.”
In summary, the challenge involves the unclear underlying cause of leukocytoclastic vasculitis despite initial treatment attempts and presumptions. Feedback underscores the necessity for further investigation and considering alternative triggers. The outcome of the feedback suggests a more comprehensive approach to determining the cause and addressing the condition effectively.
Patient Diagnosis
The patient tested negative for P-ANCA and had negative results for histo serum and urine antigens. After completing a 14-day course of antibiotics, including vancomycin during hospitalization and TMP-SMX plus cephalexin as an outpatient, the lesions scabbed over with underlying granulation. Upon resolution of cellulitis, Humira was restarted, and topical triamcinolone was applied.
The diagnosis was updated to leukocytoclastic vasculitis due to underlying Crohn’s disease with superimposed cellulitis.
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