A Patient Presenting with Palpable Purpura, Necrotising Lesions and Swelling in Bilateral Lower Extremities: Case Report

Objective: In the subtype of leukocytoclastic vasculitis, various drugs, infections and malignancies play a role in the etiology and can also be seen in ANCA-associated vasculitis, systemic connective tissue diseases, cryoglobulinemic vasculitis and IgA-vasculitis. The decisive factor in the diagnostic approach is to first determine whether the process is limited to the skin or whether there is systemic involvement. Case: 49-year-old male, no known history of chronic disease and no history of regular medication use. The patient was admitted to Cardiovascular Surgery and Dermatology clinics 10 days before the clinical evaluation with complaints of bruising, itching and swelling in the legs. Physical examination revealed polyarthralgia, bilateral ankles, palpable purpura starting from the anterior aspect of bilateral lower extremities and extending to the femur and upper extremities and necrotizing lesions with crusts on bilateral ankles. Computed tomography scan revealed thrombus distal to the aorta distal to the left subclavian artery origin, splenic infarction and right renal infarction. Skin punch biopsy pathology report was histomorphologically compatible with vasculitis and renal biopsy report was compatible with IgA-nephropathy. Methylprednisolone 0.5 mg/kg/day and Cyclophosphamide+MESNA were started with the diagnosis of IgA-vasculitis and she was in remission at the end of treatment and is under follow-up and treatment with Mycophenalate mofetil. Discussion: IgA-vasculitis can also be seen in adulthood, although less frequently, and is not always preceded by the typical clinical tetrad of abdominal cramps, arthralgia, palpable purpura and renal involvement. Cases of IgA-vasculitis are rare, especially where thrombus formations are commonly observed.