case_images: PMC9937717_01
case_images: Palpable purpura. Dark red and purple, elevated, firm, confluent round papules in the lower limbs with signs of erosion and necrosis.
case_images: cureus-0015-00000033938-i01.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i01.jpg
case_images: FIG1
case_images: On physical examination, palpable purpura and slight pretibial edema were noted in the inferior extremities (Figure 1).
case_images: 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.
case_images: cureus-0015-00000033938-i02.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i02.jpg
case_images: FIG2
case_images: Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
case_images: 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.
case_images: cureus-0015-00000033938-i03.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i03.jpg
case_images: FIG3
case_images: Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
case_images: Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.
case_images: cureus-0015-00000033938-i04.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i04.jpg
case_images: FIG4
case_images: Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
case_images: Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.
case_images: cureus-0015-00000033938-i05.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i05.jpg
case_images: FIG5
case_images: Skin biopsy revealed necrotizing vasculitis (Figures 2-5).
case_images: The purpuric rash following corticosteroid treatment.
case_images: cureus-0015-00000033938-i06.jpg
case_images: PMC9937717_01_cureus-0015-00000033938-i06.jpg
case_images: FIG6
case_images: 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). 