Clopidogrel-Induced Hypersensitivity Syndrome Presenting as a Progressive Rash: A Case Report

Q: What are the key findings of this study?

Discontinuation of clopidogrel and treatment with corticosteroids and antihistamines led to complete resolution of a progressive bilateral lower extremity rash in a 70-year-old man after 14 years of clopidogrel exposure.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Clopidogrel-induced hypersensitivity (n=1). Intervention: Clopidogrel. Primary outcome: Symptom resolution.

Q: What does this research mean for the field?

Long-term clopidogrel use can cause a progressive bilateral lower extremity rash that resolves within two weeks after discontinuation and treatment with corticosteroids and antihistamines. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Saviz Saghari; Marie Geha; Mason Arbabi; Hamayon Babary

doi:10.7759/cureus.112611

July 13, 2026CureusOpen Access

Clopidogrel-Induced Hypersensitivity Syndrome Presenting as a Progressive Rash: A Case Report

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Key result

Clopidogrel discontinuation and corticosteroids completely resolve severe delayed cutaneous hypersensitivity.

n=1

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Why the study?

Clopidogrel is widely prescribed to prevent thrombotic events in cardiovascular disease, but rare hypersensitivity reactions can complicate its use.

Key Points

To report a rare presentation of delayed clopidogrel-induced cutaneous hypersensitivity syndrome manifested as a progressive bilateral lower extremity rash.
Evaluated a 70-year-old male with coronary artery disease and approximately 14 years of clopidogrel exposure presenting with a progressive lower-extremity rash, burning pain, and pruritus.
Performed comprehensive laboratory testing for inflammatory markers, complement levels, and autoimmune serologies, alongside a diagnostic skin punch biopsy.
Discontinued clopidogrel, administered 125 mg intravenous methylprednisolone followed by systemic corticosteroids and antihistamines, and switched antiplatelet therapy to ticagrelor 90 mg orally twice daily.
Laboratory testing revealed an elevated C-reactive protein of 22.2 mg/L and a markedly reduced complement C4 level of <2 mg/dL, while complement C3 was 130 mg/dL and autoimmune antibodies were negative.
Histopathology from the skin biopsy demonstrated a superficial perivascular lymphocytic infiltrate with rare eosinophils without definitive leukocytoclastic vasculitis.
Following drug discontinuation and medical therapy, inflammatory markers trended downward and skin lesions achieved complete resolution at the two-week follow-up visit.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 70-year-old male with coronary artery disease who developed a progressive bilateral lower extremity rash after 14 years of clopidogrel therapy.

E

Exposure

Discontinuation of clopidogrel and initiation of ticagrelor 90 mg orally twice daily, along with a short course of systemic corticosteroids (125 mg IV methylprednisolone initially) and oral antihistamines.

O

Outcome

Resolution of progressive bilateral lower extremity rash and pruritus.safety

Clopidogrel-induced hypersensitivity can present as a delayed progressive purpuric rash even after 14 years of exposure, and can be successfully managed by switching to ticagrelor alongside short-term corticosteroids and antihistamines.

Limitations

Absence of rechallenge
Atypically prolonged latency
Possible contribution of a recent upper respiratory infection
Nonspecific histopathologic findings
Atypically prolonged latency of 14 years
Improvement cannot be attributed solely to clopidogrel withdrawal because systemic corticosteroids and antihistamines likely contributed

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Implication

Consider delayed clopidogrel hypersensitivity in unexplained late rashes; single case leaves open true incidence and optimal strategies.

Abstract

Clopidogrel is a commonly prescribed antiplatelet agent used to prevent thrombotic events, particularly in patients with cardiovascular disease. While effective, hypersensitivity reactions, though rare, can complicate its use. We present the case of a 70-year-old male with a history of coronary artery disease who developed a progressive bilateral lower extremity rash following long-term clopidogrel use. Laboratory findings revealed elevated inflammatory markers, and a skin biopsy showed superficial perivascular lymphocytic infiltrate with rare eosinophils. The patient was diagnosed with clopidogrel-induced hypersensitivity, leading to discontinuation of the drug and initiation of ticagrelor. A short course of systemic corticosteroids and antihistamines resulted in symptom resolution within two weeks.

Discussion

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Cite This Study

Saghari et al. (2026) conducted a case report in Clopidogrel-induced hypersensitivity (n=1). Clopidogrel was evaluated on Symptom resolution. Discontinuation of clopidogrel and treatment with corticosteroids and antihistamines led to complete resolution of a progressive bilateral lower extremity rash in a 70-year-old man after 14 years of clopidogrel exposure.

synapsesocial.com/papers/6a5874242b46c88ba9ad057d https://doi.org/10.7759/cureus.112611

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Clopidogrel-Induced Hypersensitivity Syndrome Presenting as a Progressive Rash: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clopidogrel-Induced Hypersensitivity Syndrome Presenting as a Progressive Rash: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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