PMC9937717_01
Palpable purpura. Dark red and purple, elevated, firm, confluent round papules in the lower limbs with signs of erosion and necrosis.
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FIG1
On physical examination, palpable purpura and slight pretibial edema were noted in the inferior extremities (Figure 1).
Leukocytoclastic vasculitis (H&E staining) The vessel walls are thickened due to adipose tissue and fibrin deposits, as well as the presence of diffuse lymphoplasmacytic and neutrophilic infiltrates. Presence of endothelial edema, extravasated RBCs, and polymorphonuclear inflammatory cells involving the superficial dermis layer.
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FIG2
Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
Leukocytoclastic vasculitis (H&E staining) The vessel walls are thickened due to adipose tissue and fibrin deposits, as well as the presence of diffuse lymphoplasmacytic and neutrophilic infiltrates. Presence of endothelial edema, extravasated RBCs, and polymorphonuclear inflammatory cells involving the superficial dermis layer.
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FIG3
Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.
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FIG4
Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.
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FIG5
Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
The purpuric rash following corticosteroid treatment.
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FIG6
Cutaneous lesions along with renal function started improving rapidly within two weeks following the initiation of the corticosteroid therapy, with levels of serum creatinine and albuminuria decreasing to 2 mg/dL and 1.8 g/24h, respectively (Figure 6). 