CAPECITABINE INDUCED VASCULITIS MIMICKING IGA VASCULITIS IN A PATIENT WITH CHRONIC HEPATITIS B: A CASE REPORT
DOI:
https://doi.org/10.55374/jseamed.v10.274Keywords:
capecitabine, leukocytoclastic vasculitis, IgA vasculitis, colon cancer, drug-induced vasculitis, chemotherapy adverse eventsAbstract
Capecitabine is a cornerstone of adjuvant therapy for colorectal cancer. While dermatologic toxicities such as hand-foot syndrome are well-recognized, cutaneous small-vessel vasculitis remains an exceptionally rare complication. We present the case of a 59-year-old female with stage II mucinous adenocarcinoma of the colon and concurrent chronic Hepatitis B infection. During her eighth cycle of adjuvant capecitabine and oxaliplatin (CapeOx), she presented with extensive palpable purpura on the extremities and evidence of renal involvement. Histopathology of a skin biopsy confirmed leukocytoclastic vasculitis, and direct immunofluorescence demonstrated IgA and IgM deposition. Sustained viral suppression excluded Hepatitis B reactivation, favoring a drug-induced etiology despite positive autoimmune serology. Discontinuation of the chemotherapy resulted in the complete resolution of both cutaneous and renal manifestations. This case illustrates the diagnostic complexity of distinguishing drug-induced vasculitis from viral etiologies in patients with comorbidities and underscores the need for prompt recognition to prevent systemic organ damage.
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Haller DG, Tabernero J, Maroun J, Braud F de,Price T, Cutsem EV, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancer. J Clin Oncol 2011; 29: 1465-71. DOI: https://doi.org/10.1200/JCO.2010.33.6297
Twelves C, Wong A, Nowacki MP, Abt M, Burris H 3rd, Carrato A, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005; 352: 2696-704. DOI: https://doi.org/10.1056/NEJMoa043116
Lassere Y, Hoff P. Management of hand-foot syndrome in patients treated with capecitabine (Xeloda). Eur J Oncol Nurs 2004; 8 Suppl 1: S31-40. DOI: https://doi.org/10.1016/j.ejon.2004.06.007
Carlson JA, Cavaliere LF, Grant-Kels JM. Cutaneous vasculitis: diagnosis and management. Clin Dermatol 2006; 24: 414-29. DOI: https://doi.org/10.1016/j.clindermatol.2006.07.007
Gota CE, Calabrese LH. Diagnosis and treatment of cutaneous leukocytoclastic vasculitis. Int J Clin Rheumatol 2013; 8: 49-60. DOI: https://doi.org/10.2217/ijr.12.79
Jallouli, M., M. Frikha, M. Snoussi. Cutaneous leukocytoclastic vasculitis induced by apecitabine. J Gastrointest Oncol 2013: E7-E10.
Belrhali I, Lamsyah O, Naciri S, Ruck S, Mrabti H, Errihani H. Capecitabine-induced leukocytoclastic vasculitis in a patient with colorectal cancer: A case report. Acad Med Surg, September 8, 2025. Published online DOI: https://doi.org/10.62186/001c.144049
Al-Hader A, Al-Kali A, Cortese C. Capecitabine-induced leukocytoclastic vasculitis under neoadjuvant chemotherapy for locally advanced colorectal cancer. J Gastrointest Oncol 2015; 6: E15-E18.
Holder SM ten, Joy MS, Falk RJ. Cutaneous and systemic manifestations of drug-induced vasculitis. Ann Pharmacother 2002; 36: 130- 47. DOI: https://doi.org/10.1345/1542-6270(2002)036<0130:CASMOD>2.0.CO;2
Guillevin L, Mahr A, Callard P, et al. Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore) 2005; 84: 313-22. DOI: https://doi.org/10.1097/01.md.0000180792.80212.5e
Ramos-Casals M, Stone JH, Cid MC, Bosch X. The cryoglobulinaemias. Lancet 2012; 379: 348-60. DOI: https://doi.org/10.1016/S0140-6736(11)60242-0
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013;65: 1-11. DOI: https://doi.org/10.1002/art.37715
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239-45. DOI: https://doi.org/10.1038/clpt.1981.154
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