SHM Converge Scientific Abstract ePoster Gallery-A Case of Leukocytoclastic Vasculitis Presenting With Bilateral Lower Extremity Rash and Proteinuria

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This case report describes a 54-year-old man who presented with two weeks of bilateral lower-extremity swelling and a burning purpuric rash, along with sore throat, nasal congestion, epistaxis, and “bubbly” urine. Examination showed pitting edema and scattered purpuric papules with violaceous bullae on the legs, buttocks, and forearms. Laboratory testing demonstrated acute kidney injury, significant proteinuria consistent with nephrotic syndrome, and elevated inflammatory markers. Rheumatologic and infectious workup was negative. Renal ultrasound suggested medical renal disease.<br /><br />Skin biopsy showed small-vessel injury with perivascular neutrophilic infiltration, karyorrhectic debris, and erythrocytes, supporting leukocytoclastic vasculitis (LCV). The authors note that LCV is a small-vessel vasculitis often caused by immune-mediated neutrophilic injury and may be triggered by infections, medications, connective tissue disease, or systemic vasculitides. In this patient, the most likely trigger was a recent upper respiratory infection.<br /><br />The case emphasizes that LCV can present with systemic involvement and may mimic more severe vasculitides such as ANCA-associated vasculitis. Because renal disease is common in LCV, a careful skin exam is important, especially when lesions occur above the waist, as this may correlate with kidney involvement. When systemic symptoms are present, clinicians should evaluate for broader systemic vasculitis and use both clinical findings and histopathology to guide diagnosis.<br /><br />The patient was treated with prednisone 60 mg daily for five weeks, which led to resolution of the skin lesions. He was also started on dapagliflozin and valsartan for renal protection. A renal biopsy was planned as an outpatient procedure, but the patient was lost to follow-up. The report concludes that systemic involvement in LCV should always be assessed to determine the need for escalated therapy.

Asset Subtitle

Ethan Molitch-Hou

Meta Tag

Author List Allison S. Liu, Ethan Molitch-Hou, Rahul Sandella, MD

Category Clinical Vignettes

Concept Leukocytoclastic Vasculitis

Concept Systemic Involvement

Concept Histopathology

Concept Biopsy

Concept Renal Disease

Distinguished Non-Finalist

Presenter Organization Department of Medicine, University of Chicago Medicine

Presenting Author Ethan Molitch-Hou

Track Adult

Keywords

leukocytoclastic vasculitis

small-vessel vasculitis

purpuric rash

nephrotic syndrome

acute kidney injury

proteinuria

skin biopsy

renal involvement

upper respiratory infection

prednisone treatment

Leukocytoclastic Vasculitis

Systemic Involvement

Histopathology

Biopsy

Renal Disease