title: Leukocytoclastic vasculitis associated with insulin aspart in a patient with type 2 diabetes.
abstract: OBJECTIVE
  To report a case of leukocytoclastic vasculitis associated with insulin aspart therapy.
  
  
  METHODS
  A 56-year-old man was admitted to the Department of Endocrinology because of a poorly controlled Type 2 diabetes. In an attempt to reach a tight blood glucose control, an intensive diabetes management consisting of one evening dose of intermediate-acting NPH insulin and three preprandial doses of short-acting insulin aspart was introduced. Two weeks following insulin aspart introduction the patient developed palpable purpura on distal parts of the upper and lower limbs. Four days after the onset of purpura, a skin biopsy was preformed. Histological examination showed vasculitis with perivascular infiltrates of lymphocytes and erythrocyte extravasation. Direct immunofluorescence was negative. On the day the purpuric eruptions appeared, insulin aspart was substituted with regular human insulin. All skin lesions disappeared spontaneously within 8 days. Insulin aspart was not re-administered.
  
  
  CONCLUSIONS
  Other possible causes of vasculitis in this case were excluded by diagnostic tests. The temporal relationship between the insulin aspart administration and the occurrence of purpura, with no further episodes of skin eruptions after discontinuation of the drug, support the hypothesis of an insulin aspart caused vasculitis. Based on the Naranjo's algorithm, the adverse drug reaction could be considered possible.
  
  
  CONCLUSIONS
  Clinicians should be aware of the possibility of leukocytoclastic vasculitis occurring during insulin aspart treatment.
authors.affiliation: Department of Clinical Pharmacology, University Hospital Dubrava, Zagreb, Croatia. srmarusic@inet.hr
authors.forename: S
authors.initials: S
authors.lastname: Marusic
authors.forename: V
authors.initials: V
authors.lastname: Vlahovic-Palcevski
authors.forename: D
authors.initials: D
authors.lastname: Ljubanovic
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D061267:Insulin Aspart; D008297:Male; D008875:Middle Aged; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart