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el acenocumarol por heparina&#46; En la anal&#237;tica present&#243; aumento de PCR con serolog&#237;as e inmunolog&#237;a normales &#40;factor reumatoide&#44; complemento&#44; ANA&#44; ANCA&#44; crioglobulinas&#41; y hematuria&#46; La artrocentesis de rodilla obtuvo un l&#237;quido sinovial de caracter&#237;sticas normales&#46; Se realizaron biopsias de las lesiones cut&#225;neas con diagn&#243;stico de vasculitis leucocitocl&#225;stica&#44; siendo la inmunofluorescencia directa &#40;IFD&#41; negativa&#46; El cuadro se relacion&#243; con una infecci&#243;n respiratoria previa&#59; se paut&#243; tratamiento con prednisona a dosis de 5<span class="elsevierStyleHsp" style=""></span>mg al d&#237;a con mejor&#237;a y se le dio el alta reintroduciendo el acenocumarol&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dos d&#237;as tras la reintroducci&#243;n&#44; present&#243; nuevo brote de lesiones cut&#225;neas&#44; esta vez con la formaci&#243;n de ampollas hemorr&#225;gicas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se repitieron la anal&#237;tica y las biopsias&#46; Se observ&#243; proteinuria asociada a hematuria con funci&#243;n renal normal y el an&#225;lisis dermatopatol&#243;gico mostr&#243; vasculitis leucocitocl&#225;stica de nuevo&#44; esta vez con IFD positiva para IgA y C3 en las paredes vasculares&#46; Con todo ello&#44; se sospech&#243; vasculitis por IgA asociada a acenocumarol&#46; Se suspendi&#243; el acenocumarol y se inici&#243; apixaban&#44; se pautaron tres pulsos de metilprednisolona &#40;125<span class="elsevierStyleHsp" style=""></span>mg intravenoso&#41; con posterior dosis de prednisona 15<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a en pauta descendente suspendiendo la corticoterapia en el plazo de 2 meses&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Desde la suspensi&#243;n del acenocumarol&#44; hace 6 meses&#44; el paciente no ha vuelto a presentar lesiones cut&#225;neas y las alteraciones anal&#237;ticas urinarias se han corregido por completo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discusi&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">Los efectos adversos cut&#225;neos del acenocumarol son las equimosis&#44; el s&#237;ndrome del dedo azul&#44; la necrosis cut&#225;nea&#44; las erupciones maculopapulares y la fotosensibilidad&#46; La vasculitis es un efecto adverso poco descrito en la literatura<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a>&#46; Se presenta un caso de vasculitis por IgA &#40;enfermedad de Sch&#246;nlein-Henoch&#41; secundaria a acenocumarol&#46; El diagn&#243;stico de causalidad se basa en la clara relaci&#243;n temporal de la cl&#237;nica con la administraci&#243;n del f&#225;rmaco y su reintroducci&#243;n&#44; remitiendo al suspenderlo<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La vasculitis por IgA se produce por el dep&#243;sito de complejos inmunitarios&#46; Se ha sugerido la participaci&#243;n de diversos ant&#237;genos inductores como las infecciones de las v&#237;as respiratorias altas y algunos f&#225;rmacos&#46; La cl&#237;nica consiste en p&#250;rpura palpable&#44; poliartralgias&#44; glomerulonefritis leve con proteinuria y hematuria microsc&#243;pica &#40;como en el caso que presentamos&#41; y dolor abdominal&#46; En los adultos son menos frecuentes las molestias iniciales localizadas en el intestino<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de la vasculitis IgA se basa en signos y s&#237;ntomas cl&#237;nicos&#46; El estudio histopatol&#243;gico de la piel es &#250;til para confirmar la vasculitis leucocitocl&#225;stica con dep&#243;sito de IgA y C3 por inmunofluorescencia&#46; La biopsia renal rara vez es necesaria para el diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hasta el momento hay 5 casos reportados en la literatura de vasculitis por acenocumarol<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;4&#8211;7</span></a> y de todos ellos&#44; tan solo uno es una vasculitis por IgA&#46; En estos casos&#44; la cl&#237;nica aparece entre los 2 y 20 d&#237;as tras la introducci&#243;n del tratamiento y el cuadro se resuelve tras su suspensi&#243;n&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se presenta el segundo caso de vasculitis IgA asociada a acenocumarol&#46; Debemos ser conscientes de este efecto adverso y recomendar la suspensi&#243;n del f&#225;rmaco cuando la relaci&#243;n temporal entre la administraci&#243;n y el inicio de la cl&#237;nica sea sugestiva&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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