case_images: PMC4532025_01
case_images: Pin-head to match-head sized discrete or grouped palpable purpurae are present on the lower extremites.
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case_images: Numerous nontender palpable purpura, located primarily on the lower extremities, were present with pretibial pitting edema (Fig. 1).
case_images: 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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case_images: 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).
case_images: 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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case_images: 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).
case_images: Most glomeruli reveal diffuse mesangial proliferation with cellular crescent formation (PAS stain, x 200).
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case_images: There were fibrous crescents associated with adhesion of Bowman's capsule (Fig. 4).
case_images: 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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case_images: 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).
case_images: Direct immunofluorescent stain for IgA demonstrates strong mesangial positivity (DIF for IgA, x 200).
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case_images: 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).