UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Lori A. Spencer, MD, PhD., Matthew J. Zirwas, MD, Hina Sheikh, MD, and Drazen M. Jukic, MD, PhD
JUNE 2006 CASE OF THE MONTH
CLINICAL FINDINGS
A 42-year-old male presented to the ER with chief complaint of joint pain and swelling x 4 days. Eight days prior to presentation he had been experiencing fever and night sweats, along with sore throat and enlarged cervical lymph nodes. His PCP prescribed amoxicillin. Once his fever resolved, he noticed a rash over his knees, elbows, IP joints, and buttocks. Upon review of systems, the patient admitted to abdominal pain over the past several days. Physical exam and laboratory studies: On exam, he was afebrile with stable vital signs. He had swelling and tenderness over his left knee, right ankle and both wrists. A petechial rash was present on his hands, feet, and toes. He had palpable purpura on his buttocks. He had an elevated WBC count of 14.4. His ESR was elevated at 43. A comprehensive metabolic panel was done in the ER, which was within normal limits including a BUN of 20 and creatinine of 1.1. However, his urinalysis was notable for 1+ bilirubin and 1+ blood. Blood, urine, and synovial fluid cultures were done, and the patient was empirically treated with ceftriaxone to cover for meningococcus. Once an infectious etiology was ruled out, the patient treated with a brief course of oral prednisone, although he had improved significantly prior to the start of steroids.
We were consulted to see the patient regarding his petechial rash. Two punch biopsies were performed, one each for H&E and immunofluorescence, respectively. The biopsy revealed leukocytoclastic vasculitis with areas of red blood cell extravasation. There were granular deposits of IgA around superficial dermal blood vessels. These findings are consistent with a diagnosis of Henoch-Schonlein purpura. See Figures.
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