Discussion
American College of Rheumatology has defined LCV as the presence of three or more of the following five criteria: 1) age > 16 years, 2) history of taking a medication at onset, 3) the presence of palpable purpura, 4) the presence of maculopapular rash, and 5) a biopsy demonstrating granulocytes around an arteriole or a venule (LCV)6. In our patient, four out of the five criteria were met and hence the diagnosis of LCV was made. It is usually difficult to find the cause of LCV. It is idiopathic (in approximately half of cases) or secondary to drugs or infections7. In our case, the patient had no history of fever and the investigations didn’t show any possibility of infection. The stoppage of tenofovir resolved the vasculitis. Hence, tenofovir was suspected as the etiological agent.
Studies show that the occurrence of cutaneous adverse effects due to tenofovir ranges from 5% to 18% which includes maculopapular rash, urticaria, pustules, pruritus, vesiculobullous rash4,5However, they are underreported in the literature. The reported cutaneous adverse events from the use of tenofovir are summarized in Table 1.