SHM Converge Scientific Abstract ePoster Gallery-You Don't Want to Miss This Rash: A Systematic Approach to Palpable Purpura

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A 61-year-old man with type 2 diabetes developed a painful, palpable purpuric rash on postoperative day 4 after surgery for osteomyelitis. He had been started on vancomycin and cefepime. The rash was concentrated on the posterior calves with some lesions on the hands, while the palms and soles were spared. He remained hemodynamically stable, and his CBC and chemistries were unchanged. HIV and HCV testing were negative. After dermatology evaluation and biopsy, the antibiotics were stopped, the rash improved with topical clobetasol, and therapy was switched to doxycycline.<br /><br />The case highlights leukocytoclastic vasculitis (LCV), a cutaneous small-vessel vasculitis that presents as acute palpable purpura, often in dependent areas. It is usually triggered by medications such as antibiotics or hydrochlorothiazide, infections such as hepatitis C, autoimmune disease, or may be idiopathic. Biopsy typically shows neutrophilic infiltration of vessel walls with leukocytoclasia, fibrinoid change, and minimal or absent immune complex deposition.<br /><br />Purpuric, nonblanching lesions suggest vascular injury or inflammation. In hospitalized patients, the differential diagnosis for palpable purpura includes meningococcemia, septic vasculitis, ITP, Sweet syndrome, Rocky Mountain spotted fever, autoimmune disease, and Henoch-Schönlein purpura.<br /><br />Management of LCV focuses on identifying and removing the underlying trigger while using topical steroids for symptom relief. This case emphasizes that acute painful purpura in the inpatient setting should prompt consideration of drug-induced vasculitis, especially after new antibiotic exposure.

Asset Subtitle

Katherine A. Peacock

Meta Tag

Author List Jerald L. Taggart, Katherine A. Peacock

Category Clinical Vignettes

Concept Purpura

Concept Leukocytoclastic Vasculitis

Concept Skin Biopsy

Concept Medication

Concept Infection

Distinguished Non-Finalist

Presenter Organization Tulane University

Presenting Author Katherine A. Peacock

Track Adult

Keywords

leukocytoclastic vasculitis

palpable purpura

drug-induced vasculitis

vancomycin

cefepime

antibiotic reaction

cutaneous small-vessel vasculitis

posterior calves

topical clobetasol

biopsy

Purpura

Leukocytoclastic Vasculitis

Skin Biopsy

Medication

Infection