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The patient's swollen left knee (A) and vasculitic lesions on the lower limb (B).
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A 35-year-old man presented with arthralgia in the large joints, a palpable purpuric rash on both legs, swelling of the left knee (Fig. 1), difficulty swallowing, and epigastric discomfort for 2 weeks.
Light (A: H&E, x200; B: PAS, x200) and immunofluorescence (C) microscopy of the renal biopsy, and light microscopic images (D: H&E, x400) of the skin biopsy. (A) and (B) show mesangial cellular proliferation (arrows), and increased mesangial matrix production, respectively. (C) depicts mesangial deposits of immunoglobulin A. (D) shows perivascular polymorphic neutrophil infiltration and extravasated erythrocytes (arrows).
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A renal biopsy was compatible with IgA nephropathy (Fig. 2).