PMC4978839_01
Palpable purpura on the lower extremities with ankle edema and arthritis.
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fig1
A 33-year-old Caucasian man with ulcerative colitis for three years in endoscopic and near histologic remission three months before, on adalimumab 40 mg every two weeks (Abbvie, North Chicago, IL), with therapeutic trough levels and no antidrug antibodies, was admitted to our hospital for workup of a recurrent erythematous, palpable, nonblanching rash on his bilateral lower extremities associated with joint pain and swelling of his ankles, knees, and elbows (Figure 1).
(a) High power hematoxylin and eosin stained slide showing leukocytoclastic vasculitis. (b) Direct immunofluorescence showing superficial dermal vascular depositions of IgA.
CRIRH2016-2812980.002.jpg
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fig2
Punch skin biopsies from the patient's right lower extremity revealed leukocytoclastic vasculitis with frequent eosinophils and direct immunofluorescence was positive for small vessel IgA deposition (Figure 2).