Leukocytoclastic Vasculitis and Disseminated Intravascular Coagulation After a Single Dose of Ceftriaxone: A Case Report and Review of the Literature

Symptoms: Deterioration of general condition • ecchymosis • hypotension • palpable purpura Clinical Procedure:-Specialty: General and Internal Medicine Background:Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that usually presents with palpable purpura localized to the lower extremities and may occur secondary to infections, drugs, malignancies, or idiopathic causes.Reports of ceftriaxone-associated LCV are limited, and presentation with concomitant disseminated intravascular coagulation (DIC) and onset within hours is exceedingly rare. Case Report:A 29-year-old woman presented to the emergency department with clinical findings suggestive of a urinary tract infection.She had no known chronic medical conditions or history of regular medication use.Within several hours of receiving a single dose of ceftriaxone, she developed widespread purpura subsequently diagnosed as LCV, accompanied by DIC.At presentation, elevated acute-phase reactants and the clinical findings initially raised suspicion of urosepsis.However, the development of widespread purpuric eruptions over the entire body prompted reconsideration of the diagnosis in favor of drug-induced vasculitis.Rapid clinical and laboratory improvement after discontinuation of the suspected causative drug and initiation of methylprednisolone indicated that a drug-induced process was predominant.Histopathological evaluation of a punch biopsy specimen confirmed the diagnosis of LCV; characteristic features included fibrinoid necrosis and erythrocyte extravasation. Conclusions:This case emphasizes that LCV can develop rapidly, mimic sepsis at initial evaluation, and occur concomitantly with severe coagulation disorders such as DIC.It also demonstrates the importance of early discontinuation of the causative drug and careful evaluation for systemic complications in patients who present with widespread purpuric eruptions.