CASE REPORT Clindamycin vasculitis in patients with peripheral arterial vascular disease Jamil Al-Jamali & Gunther Felmerer & Ahmed Kasem & Khalid Al-awadi & Ziad Kalash & G. B. Stark Received: 3 January 2009 / Accepted: 9 June 2009 / Published online: 15 July 2009 # Springer-Verlag 2009 Abstract Clindamycin was first synthesized in 1966. It is a chemical derivative of lincomycin with activity against aerobic gram-positive and gram-negative bacteria. The side effects include diarrhea, pseudomembranous colitis, metal- lic taste in the mouth, transient elevation of transaminases, granulocytopenia, thrombocytopenia, and rash. The inci- dence of maculopapular rashes has been reported to be approximately 10%. Leukocytoclastic angitis or vasculitis induced by clindamycin has been reported (Lambert et al., Cutis 30:615–619, 1982) and this is a very serious compli- cation in patients with peripheral arterial vascular diseases which may leads to severe and deep necrotizing vasculitis. We report two cases of necrotizing vasculitis due to clindamycin which was used for the treatment of chronic wounds in patients suffering of peripheral vascular disease. Keywords Chronic wounds . Peripheral arterial vascular diseases . Clindamycin vasculitis Case reports Case 1 Two cases of necrotizing vasculitis induced by clindamycin are reported. The first is a 76-year-old diabetic male who presented with delayed wound healing and two small open wounds over the left Achilles tendon after surgical reconstruction of spontaneous tendon rupture. Clinical examination showed an elderly male patient in good health. Local examination of the area revealed two open wounds with exposed necrotic Achilles tendon and mild inflamma- tory signs around the wounds (Fig. 1). Neurovascular examination of both lower limbs revealed bilateral hypo- esthesia. The pulsations of the femoral and popliteal arteries of both sides were palpable and audible with Doppler examination. The pulsation of the posterior tibial artery on the left side was not palpable and not audible, whereas those of the anterior tibial and dorsalis pedis arteries were weak, palpable, and audible. The pulsations of the right side were weak, palpable, and audible. Digital subtraction angiography of both lower limbs showed atherosclerotic changes, high-grade stenosis of the tibiofibular trunk on both sides and the posterior tibial arteries showed multi- segmental high-grade stenosis. Surgical debridement of the wound was performed and it was covered with Vaseline gauze with the addition of beta-iodine ointment and closure of the area with a sterile bandage. The decision for conservative management of the wound by the patients' general practitioner with regular follow-up and wound dressings was taken. Clindamycin 300 mg tablet three times a day (TDS) were then prescribed by the general practitioner according to the results of the antibiogram of the wound to guard against wound infection. Four days after administration, the patient developed a widespread exanthematous eruption with formation of vesicles all over the body. The patient was then transferred to the dermatol- ogy department for further management of the clindamycin allergic reaction. After 2 weeks, the rashes disappeared with the exception of deep full-thickness ulcerations of both lower limbs and feet. The patient was then referred to us for surgical management of the necrotic wounds. Local examination of both lower limbs showed the clinical picture Eur J Plast Surg (2009) 32:267–269 DOI 10.1007/s00238-009-0343-6 J. Al-Jamali (*) : G. Felmerer : A. Kasem : K. Al-awadi : Z. Kalash : G. B. Stark Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany e-mail: jamilmoh2002@hotmail.com