Leukocytoclastic Vasculitis Associated with Bortezomib Therapy.

A 28-year-old male, 10 years post live-related renal transplant with stable graft function of 1.4 mg/dL, presented with complaints of loss of appetite and vomiting for three days. On evaluation, he was found to have significant graft dysfunction with a creatinine of 10.3 mg/dL. He was initiated on hemodialysis in view of uremic gastrointestinal symptoms. Graft biopsy done revealed acute cell-mediated rejection BANFF IIB and diffuse C4d-positive antibody-mediated rejection. He was treated with intravenous methylprednisolone, therapeutic plasma exchange, and intravenous immunoglobulin therapy, following which his graft function improved gradually. He received multiple injections of bortezomib as a part of anti-rejection treatment protocol and developed peripheral neuropathy, leukocytoclastic vasculitis, and varicellosis. This case report is to highlight the unusual phenomenon of leukocytoclastic vasculitis in a post renal transplant setting secondary to bortezomib therapy.

Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor.

Hemophilia A is a hereditary X-linked recessive disease caused by mutations in the gene encoding factor VIII (FVIII), occurring in 1 out of 10,000 persons. Life expectancy and quality of life have dramatically improved recently in patients with hemophilia. Chronic kidney disease and need for renal replacement therapy in these patients are rare. The development of inhibitors to FVIII is the most serious complication of hemophilia and makes treatment of bleeds very challenging. We describe here a 28-year-old male patient with severe hemophilia A with presence of factor VIII inhibitor, who had end stage renal disease. Central venous access device was inserted along with infusion of factor eight inhibitor bypass activity before and after the procedure. He is currently on thrice weekly hemodialysis and doing well for 6 months without bleeding episodes. To our knowledge, hemophilia A with factor VIII inhibitor managed with hemodialysis has not been reported so far.