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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