PMC4532025_01
Pin-head to match-head sized discrete or grouped palpable purpurae are present on the lower extremites.
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Numerous nontender palpable purpura, located primarily on the lower extremities, were present with pretibial pitting edema (Fig. 1).
Diffuse scattered ill defined nodules noted in entire both lung fields are remarkably improved with antituberculosis medication on serial chest PA.
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The chest roentgenogram taken on admission revealed diffuse scattered, ill defined nodules in entire both lung fields and patchy and confluent density in both upper lungs(Fig. 2).
Leukocytoclastic vasculitis (anaphylactoid purpura); perivascular neutrophilic and eosinophilic infiltration with numerous scattered karyorrhectic nuclear debris and extravasation of RBCs (H&E, x 200 and x 400).
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A punch biopsy specimen of the palpable purpuric lesions on the posterior aspect of the leg was consistent with the diagnosis of "leukocytoclastic vasculitis" (Fig. 3).
Most glomeruli reveal diffuse mesangial proliferation with cellular crescent formation (PAS stain, x 200).
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There were fibrous crescents associated with adhesion of Bowman's capsule (Fig. 4).
Interstitial chronic granulomatous inflammation with central caseous necrosis (A; Massen's trichrome stain, x 40) showing focal brown positive reaction in immunohistochemical stain for Mycobacterium bovis (B; Avidin-biotin complex, x200).
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There was the evidence of interstitial chronic granulomatous inflammation with caseous necrosis, with moderate fibrosis, lymphoplasmacytic infiltration, compatible with renal involvement of tuberculosis(Fig. 5).
Direct immunofluorescent stain for IgA demonstrates strong mesangial positivity (DIF for IgA, x 200).
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Immunofluorescent findings were strong nodular mesangial Ig A deposit with trace granular Ig G deposition along peripheral capillary loops and perivascular C3 deposit(Fig. 6).