Apixaban-induced leukocytoclastic vasculitis

Introduction: Drug-induced vasculitis is a rare adverse drug reaction and the potential to induce such a reaction is often established postmarketing. Leukocytoclastic vasculitis a subtype of drug-induced vasculitis often presents itself with palpable purpuric lesions, and often within weeks of initial administration. Case-description: We present a 62-year-old male who presented with leukocytoclastic vasculitis within the first 8 days of apixaban-initiation. Symptoms improved upon discontinuation and resolved after several months of prednisone therapy. Literature review: We conducted a search on PubMed, which yielded 10 reports of leukocytoclastic vasculitis induced by NOACs, of these 10 only 1 had been caused by apixaban, 4 caused by dabigatran and 5 had been caused by rivaroxaban. Of these cases, one presented with leukocytoclastic vasculitis induced by both rivaroxaban and dabigatran, and one case presented successful switch from apixaban to rivaroxaban. Conclusion: Apixaban-induced leukocytoclastic vasculitis is a rare but serious and important adverse reaction.