071 A life-threatening rash induced by an inconspicuous drug

Drug-induced rashes are common in the elderly, but some of them can be life-threatening, and for this reason, an appropriate diagnosis treatment necessary. We present case a 71-year-old female, with atrial fibrillation, heart failure, arterial hypertension, Parkinson’s disease, who presented 2-week painful rash located on limbs. Physical examination revealed petechiae lower arm, ulcerated nodules small joints hands feet, plaques shins. Blood tests showed anemia, inflammation, impaired renal function. The presumptive clinical was cutaneous vasculitis prednisone 0.5 mg/kg clobetasol propionate started. Cutaneous biopsy concluded leukocytoclastic vasculitis. extended auto-immune panel negative. During hospitalization, patient’s general condition deteriorated, hypotension, bradycardia, oliguria. Laboratory metabolic acidosis further impairment function, leukocyturia microhematuria. patient transferred to intensive care hemodialysis. Renal ultrasound slightly enlarged kidneys. A proposed, it postponed due hemorrhagic diathesis. acute interstitial nephritis made dose increased 1 mg/kg. function gradually improved. thorough investigation that same more than 2 years, underwent short course tramadol approximately one month prior hospitalization. final tramadol-induced nephritis. In conclusion, occur elderly should carefully evaluated, ideally order ensure assessment prompt initiation treatment.