Radiocontrast-related leukocytoclastic vasculitis misdiagnosed as diabetic foot ulcer in a type 2 diabetic patient: a case report / Radyokontrast iliskili Lokositoklastik Vaskuliti Olan Diyabetik Hasta: Bir Vaka Sunumu
The skin is the most affected tissue by many vasculitis syndromes. Leukocytoclastic vasculitis is the most common type of vasculitis syndrome and involves the small vessels. A long list of causative factors has been reported for leukocytoclastic vasculitis. Here, we present a type 2 diabetic patient who had purpuric skin lesions predominantly on the lower limbs and acute renal failure overriding to underlying chronic kidney disease due to leukocytoclastic vasculitis associated with radiocontrast administration. He was initially diagnosed as having diabetic foot ulcer at our outpatient clinic. After single dose betamethasone depot 19.6 mg i.m.), skin eruptions paled and improved; renal function showed an improvement on the following days. There are few case reports on the relationship of radiocontrast agent with leucocytoclastic vasculitis. Our case had leukocytoclastic vasculitis due to radiocontrast agent exposure which is very rare in the literature. Turk Jem 2013; 17; 78-80
Key words: Leukocytoclastic vasculitis, radiocontrast agent, diabetes mellitus, renal failure
Deri bir cok vaskulit sendromundan cogunlukla etkilenir. Lokositoklastik vaskulit genellikle kucuk damarlan tutor. Lokositoklastik vaskulite sebep olan uzun bir liste bildirilmistir. Biz burada oncelikle all ekstremiteleri tutan purpurik cut lezyonlan olan ve alffa yatan kronik lobbrek yetmezligi uzerine akut bobrek yetmezligi gelismis olan radyokontrast iliskili lokositoklastik vaskulit vakasini sunmak istedik. Hasta baslangicta poliklinige diyabetik ayak ulseri tanisiyla gelmisti. Tek doz depo betametazon (9.6 mg i.m.) sonrast cut lezyonlan soldu ve duzeldi, takip eden gunlerde bobrek fonksiyonlan duzelme gosterdi. Bir kac radyokontrast iliskili lukositoklastik vaskulit vakasi bildirilmistir. Radyokontrast ilaca bagli lukositoklastik vaskulitli bu vaka literaturde cok nadirdir. Turk Jem 2013; 17: 78-80
Anahtar kelimeler: Lokositoklastik vaskulit, radyokontrast ajan, diabetes mellitus, bubrek yetmezligi
Vasculitis is a nonspecific clinicopathologic condition characterized by inflammation and necrosis of the blood vessels (1), (2). Leukocytoclastic vasculitis (LV) is the most common form seen in clinical practice.
Inflammation of the vessel wall is the basic pathology in LV and may result in structural disturbances and disrupted blood flow. It may be localized to the skin or may manifest in other organs. The joints, gastrointestinal tract, and the kidneys are the most commonly involved internal organs. The prognosis is good in the absence of internal involvement (2-4). LV can be seen as primary or secondary to an underlying systemic disease, cancer, medicines, infections and trauma. More than 70% of cases are due to drugs, infection, malign disorders, connective tissue disorders and primary vasculitis (4). Idiopathic vasculitis can be diagnosed only after exclusion of known causes.
Radiocontrast agent-related vasculitis is very rare in the literature. Here, we report a patient with type 2 diabetes mellitus (T2DM) who had LV due to lower extremity contrast-enhanced magnetic resonance angiography. Interestingly, the patient had been initially diagnosed as having diabetic foot ulcer at our outpatient clinic.
A 64-year-old male patient was hospitalized in our clinic for diabetic foot ulcer (initial diagnosis)....
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