[Antibiotics, purpura and ulcers: a leukocytoclastic vasculitis after clarithromycin].

HISTORY AND CLINICAL FINDINGS: A 47- year-old woman presented with palpable purpura of both lower limbs after taking six tablets of clarithromycin for pneumonia.

INVESTIGATIONS: Apart from mild microhematuria there were no other signs of organ involvement. Histology of a skin biopsy revealed a hypersensitivity vasculitis.

TREATMENT AND COURSE: A hypersensitivity vasculitis due to clarithromycin was the cause of the purpura. The course of this hypersensitivity vasculitis was severe and protracted over weeks with formation of deep ulcerative skin lesions.

CONCLUSION

Clarithromycin may be the cause of a hypersensitivity vasculitis: often the course of the disease is mild, but it may also lead to severe local complications. The diagnosis of hypersensitivity vasculitis can be made in a patient over 16 years of age if there is the combination of a triggering substance, purpura and leukocytoclastic vasculitis. The most important step is immediate withdrawal of the causative agent. A beneficial effect of treatment with steroids on prognosis is not proven.