Leukocytoclastic vasculitis in a patient with metastatic synovial sarcoma: A case report and review of the literatüre

We described a case that synovial sarcoma with lung metastasis, presenting with leukocytoclastic vasculitis after treatment with high dose ifosfamide. Forty-two years old male patient was admitted to the hospital due to anteromedial mass on his left arm. He was operated with the diagnosis of high grade synovial sarcoma and he received adjuvant treatment. 10 months later after the end of the therapy, numerous metastatic lung nodules developed and started high dose ifosfamide treatment. Stomachache, hematuria, erythematous lesions, palpable purpura on his bilateral lower extremities developed after 1weeks later of the starting chemotherapy. His autoantibodies were negative (anticardiolipin IG G/M, antiphospholipid Ig G/ M, antids DNA, ANA, pANCA, cANCA) and RF, C3, C4 were normal. Full-thickness skin biopsy resulted as leukocytoclastic vasculitis. After treatment 1 mg/kg prednisolone, patient's rash, hematuria, abdominal pain disappeared completely. We found that a possible relationship between ifosfamide and vasculitis according to Naranjo scale which envisioning the possibility of drug induced adverse drug effects. In the light of current knowledge, we found no cases developing leukocytoclastic vasculitis after ifosfamide treatment in the literature. Here, we wanted to emphasize that in patients treated with high dose ifosfamide might develop leukocytoclastic vasculitis, which is rare and unusual case.

Metastatik sinovyal sarkomlu hastada lökositoklastik vaskülit: Olgu sunumu ve literatürün gözden geçirilmesi

Biz, akciðer metastazý olan sinovyal sarkomlu, yüksek doz ifosfamid tedavisi sonrasý lökositoklastik vaskülit geliþen bir olguyu tanýmladýk. Kýrk iki yaþýnda erkek hasta, sol kol ön-iç kýsýmda geliþen kitle nedeniyle baþvurdu. Operasyon sonrasý yüksek gradlý sinovyal sarkom tanýsýyla adjuvan tedavilerini aldý. Tedavi bitiminden 10 ay sonra, çok sayýda akciðer metastatik nodülleri nedeniyle yüksek doz ifosfamide tedavisi baþlandý. Kemoterapiyi takiben 1 hafta sonra hastada karýn aðrýsý, kanlý idrar ve her iki alt ekstremitede eritematöz lezyonlar ve palpable purpura geliþti. Hastanýn otoantikorlarý negatif (antikardiyolipin IgG/M, antifosfolipid IgG/M, anti dsDNA, ANA, pANCA ve cANCA), RF normal, C3 ve C4 normal sýnýrlarda saptandý. Deriden yapýlan tam kat deri biopsisi lökositoklastik vaskülit ile uyumlu geldi. 1mg/kg prednizolon tedavisi sonrasýnda hastanýn döküntüleri, kanlý idrar ve karýn aðrýsý tamamýyla geriledi. Ýlaca baðlý olumsuz ilaç etkisi ihtimalini öngören Naranjo skalasýna göre vaskülit ile ifosfamid arasýnda olasý bir iliþki olabileceðini saptadýk. Güncel bilgiler ýþýðýnda literatürde ifosfamid sonrasý lökositoklastik vaskülit geliþen olguya rastlamadýk. Biz, burada, yüksek doz ifosfamid alan hastalarda nadir ve olaðan dýþý bir durum olan lökositoklastik vaskülit geliþebileceðini vurgulamak istedik.