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A case of polymorphic dermal angiitis in a B-cell chronic lymphocytic leukemia patient during rituximab therapy.

OBJECTIVE
The aim of the study is to describe a case is of clinical interest as the first known occurrence of skin vasculitis during rituximab treatment. The article describes a case of polymorphic dermal angiitis, a combination of hemorrhagic and ulcerative-necrotic forms against the background of rituximab treatment in a 53-year-old woman suffering from chronic lymphocytic leukemia (b-CLL). During four hours after the 5th intravenous administration of rituximab, the appearance of painful rashes on the skin of both shins of a patient was observed. In the following few days, a progression of the pathological skin process was noted.


METHODS
The treatment with prednisolone in the amount of 50 mg/day, amoxicillin and clavulanic acid in the amount of 1000 mg twice per day and Diflucan in a dosage of 50 mg/day for 15 days was prescribed. In a local therapy, wet-drying bandages with antiseptic solutions, combined topic glucocorticosteroid preparations, drugs that improve trophic and tissue regeneration were recommended.


RESULTS
After discharge, the patient continued to receive prednisolone in the amount of 50 mg/day for 14 days with a slow decrease in the dosage of the drug until the withdrawal under the supervision of a dermatologist.


CONLUSIONS
The described experience of how combined forms of polymorphic dermal angiitis are developing can be considered a result of toxic drug response to rituximab.