LAUSR

results were normal, including C reactive protein, erythrocyte sedimentation rate, blood counts, urinalysis, and serum complement levels, antinuclear antibodies, antiextractable nuclear antigens, rheumatoid factor, antineutrophil cytoplasmic antibodies, antiphospholipid antibodies, and cryoglobulins. A skin biopsy revealed features of leukocytoclastic vasculitis in postcapillary venules: dermis with superficial perivascular neutrophilic infiltrate, leukocytoclasis, edema, red blood cell extravasation, and fibrinoid necrosis of blood vessel walls (Fig. 1B). This finding was suggestive of cutaneous drug-induced vasculitis. Soon after the appearance of the purpuric lesions on thighs, legs, and ankles, prednisone was introduced at a dose of 60 mg qd (1 mg/kg), and adalimumab was discontinued. However, only a modest response was observed after 30 days of glucocorticoid therapy, and purpuric lesions at ankles and feet remained. We introduced colchicine 0.5 mg tid, after breastfeeding, and tapered prednisone to 40 mg per day. At this point, there were no laboratory abnormalities. Skin lesions gradually disappeared, and after 30 days of treatment, there were no visible active lesions. Prednisone was tapered progressively and maintained at minimal dose just to control Crohn’s disease. Colchicine was also tapered and maintained at a dose of 0.5 mg/day. This case report illustrates cutaneous vasculitis as a potential association with anti–tumor necrosis factor-a therapy. In addition to stopping the suspected drug, colchicine may be helpful in patients refractory to high-dose glucocorticoids.