Nifuratel induced anaphylactoid purpura

A 57-year-old female with vaginitis received oral nifuratel 0.4 g thrice daily and nifuratel vaginal tablets 250 mg once every night for topical use. After 13 days of treatment, the patient developed red rashes on generalized skin with itching. Laboratory tests showed the following values: white blood cell (WBC) count 7.8×109/L, neutrophil 0.70, lymphocytes 0.20, eosinophil 0.006, platelet (PLT) 185×109/L, and erythrocyte sedimentation rate (ESR)54 mm/1 h. She was given IM injection of diphenhydramine 20 mg, oral loratadine 10 mg and cetirizine 10 mg once daily. But the patient's symptoms were not improved and her rashes exacerbated and accompanied by fever, her rashes can be seen on both face and body shin accompanied with rashes area and number increasing.Three days later, the patient developed edematous erythema on her trunk and upper limbs, a large pieces of dark red ecchymosis on her both lower limbs. Laboratory test showed ESR was 68 mm/1 h. The patient was diagnosed as anaphylactoid purpura with infection. Nifuratel, loratadine, and cetirizine were stopped and IV infusion of azithromycin 0.5 g and methylprednisolone 80 mg once daily were given. After 2 days of treatments, the rashes partly disappeared, azithromycin 0.5 g and prednisone 5 mg once daily were given by mouth and 3 days later, the rashes disappeared. Azithromycin was stopped and oral prednisone 5 mg once daily was given. After 4 days of treatment, the rashes completely disappeared. Prednisone was stopped. Key words: Nifuratel; Purpura, Schoenlein-Henoch