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General Rehabilitation

Cefazolin-induced Leukocytoclastic Vasculitis in the Inpatient Rehabilitation Setting: A Case Report

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 2
Has Audio

    Primary Author(s)

  • Harrison Jordan, DO

    Resident
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Poster Presenter(s)

  • Samantha Greenman, DO

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Co-Author(s)

  • JP

    Jacob Pannaman, DO

    Resident
    Campbell University Jerry M Wallace School of Osteopathic Medicine
    Winterville, North Carolina

  • TH

    Terri Howard, Pharm.D (she/her/hers)

    Clinical Pharmacist
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • RM

    Raymund Millan, MD

    SCI Director , Attending Physician
    Vidant Medical Center/East Carolina University PM&R Program
    Greenville, North Carolina

Disclosure(s):
Harrison Jordan, DO: No financial relationships to disclose
Samantha Greenman, DO: No financial relationships to disclose
Terri Howard, Pharm.D: No financial relationships to disclose
Raymund Millan, MD: No financial relationships to disclose
Case Diagnosis: We present a case of a 71-year-old male with late onset cefazolin-induced leukocytoclastic vasculitis in the inpatient rehabilitation setting.

Case Description or Program Description: This patient was admitted to inpatient rehabilitation post-operative day 11 status post washout of lumbar wound and revision for impaired activities of daily living (ADLs) secondary to infection of the lumbar spine and revision of spinal hardware. The patient was placed on Cefazolin to treat the infection of lumbar hardware for 6 weeks. During rehabilitation admission, the patient developed a purpuric rash on the bilateral lower extremities on day 14 of treatment with Cefazolin. Infectious disease consulted and thought drug-induced vasculitis was unlikely due to the time frame of onset of symptoms. The patient was started on a short course of prednisone due to worsening pain and itching associated with the rash. A skin biopsy was performed, and a diagnosis of leukocytoclastic vasculitis was made based on histopathology. While an unlikely etiology of the rash due to the delayed onset, cefazolin was subsequently discontinued and transitioned to doxycycline to complete a 6-week course.

Setting: Inpatient Rehabilitation

Assessment/Results: The purpuric rash began to improve after discontinuation of cefazolin, and an almost complete resolution of the purpuric rash was present during outpatient follow-up. The patient was tolerating doxycycline without issue.

Discussion (relevance): Leukocytoclastic vasculitis pathophysiology refers to debris of neutrophils accumulating within blood vessel walls. This case is a rare example of delayed onset leukocytoclastic vasculitis that was atypical in course and presentation. There are other reports of leukocytoclastic vasculitis, however the etiology half the time is unknown and there are few cases reported in the inpatient rehabilitation setting.

Conclusions: Delayed onset of Leukocytoclastic Vasculitis should be considered in patients with new onset rash in the inpatient rehabilitation setting, and drug-induced rash must always be high on the differential regardless of timeline and duration of therapy.