Leukocytoclastic vasculitis induced by Nateglinide

Abstract

Meglitinides, a class of drug used in type 2 diabetes mellitus, includes repaglinide and nateglinide and is associated with hypoglycemia, nausea, diarrhea and peripheral edema. We report a unique adverse reaction to nateglinide. A 55-year-old Caucasian male presented with a diffuse rash on his skin which started on his ankles bilaterally 3 weeks before presentation. Examination revealed a diffuse patchy maculo-papular rash, with some patches having pustules, purpura and eschar. Skin biopsy showed areas of fibrinoid deposition with wall thickening in superficial dermal blood vessels. The patient was recently started on nateglinide three months prior to admission at dose of 120 mg three times a day. During hospitalization, his nateglinide was stopped and started on oral prednisone 60 mg daily. His lesions improved over the next one week