SHM Converge Scientific Abstract ePoster Gallery-Leukocytoclastic Vasculitis and Cryoglobulinemia as Sequelae From Infective Endocarditis

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This case describes a 33-year-old pregnant woman with chronic hepatitis C and intravenous drug use who presented with fever, abdominal pain, hematuria, altered mental status, and signs of sepsis. Workup showed acute renal dysfunction, multifocal lung opacities concerning for septic emboli or pneumonia, and transthoracic echocardiography revealed vegetations on the tricuspid, aortic, and mitral valves. Blood cultures grew methicillin-sensitive Staphylococcus aureus, confirming infective endocarditis.<br /><br />During hospitalization, she developed a diffuse palpable purpuric rash and polyarthralgias. Skin biopsy demonstrated pustular leukocytoclastic vasculitis (LCV), and direct immunofluorescence showed faint granular C3 deposition in superficial dermal vessels without IgG, IgA, IgM, or fibrinogen. These findings supported immune complex–mediated septic vasculitis related to infective endocarditis rather than hepatitis C–related cryoglobulinemia. Complement levels were normal, though they were measured after treatment had begun.<br /><br />The discussion highlights that purpuric skin lesions in infective endocarditis are common and may be due to complement deposition in small vessels. Although cryoglobulinemic vasculitis is classically associated with hepatitis C, it can also occur with infective endocarditis. In this patient, the very low hepatitis C viral load and biopsy findings favored complement-mediated LCV triggered by endocarditis. The report emphasizes the importance of early skin biopsy in patients with suspected endocarditis who develop purpura, especially when hepatitis C or other potential causes of vasculitis are present. Correct diagnosis is critical because steroid treatment, which may be used for hepatitis C-associated vasculitis, would be inappropriate and potentially harmful in active bacterial endocarditis.

Asset Subtitle

Kellee Taylor

Meta Tag

Author List Frederick S. Southwick, Kellee Taylor, Kiran Lukose, Neha Solanky, Nicolas N. Kattan

Category Clinical Vignettes

Concept Leukocytoclastic Vasculitis

Concept Infective Endocarditis

Concept Cryoglobulinemic Vasculitis

Concept Palpable Purpura

Concept Septic Emboli

Distinguished Non-Finalist

Presenter Organization University of Florida

Presenting Author Kellee Taylor

Track Adult

Keywords

infective endocarditis

Staphylococcus aureus

leukocytoclastic vasculitis

septic vasculitis

pregnancy

hepatitis C

purpuric rash

immune complex

tricuspid valve vegetation

skin biopsy

Leukocytoclastic Vasculitis

Infective Endocarditis

Cryoglobulinemic Vasculitis

Palpable Purpura

Septic Emboli