Etanercept-Induced IgA vasculitis: A Case Report

Abstract

Introduction: IgA vasculitis is a subtype of leukocytoclastic vasculitis. Approximately 90% of cases of IgA vasculitis are seen in the pediatric population. Causes of IgA vasculitis may be idiopathic or may be secondary to infections or medications. Etanercept has been rarely associated with IgA vasculitis.

Case presentation: A 59-year-old female presented with a 2-year history of red bumps on the bilateral lower extremities.  She noted that after etanercept administration she would get new lesions and the existing lesions would be more red and painful.  Examination showed red-to-violaceous purpuric papules on the bilateral lower extremities and a few purpuric papules on the arm and abdomen. A biopsy of the lesion showed leukocytoclastic vasculitis. Direct immunofluorescence showed granular deposition of IgA and C3 within small vessels, consistent with IgA vasculitis.

Conclusion: IgA vasculitis is a serious illness that may be associated with systemic organ involvement. It can lead to chronic renal insufficiency and require dialysis. Identifying an underlying etiology may allow treatment that resolves this condition. We identified a patient whose disease was exacerbated by etanercept therapy and was “80%” better 4 weeks after stopping etanercept. She had complete resolution of remaining lesions within 2 weeks of starting colchicine therapy. She remained symptom-free at 11 months after discontinuation of etanercept therapy. As biologic therapy use becomes increasingly prevalent, associated adverse events are expected to similarly become more frequent. When a cause can be identified, a patient like our patient can be cured.