Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

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Diagnose this case by Rahul Nanda, MD, and Zeinah AlHalees, MD

An otherwise healthy 25-year-old male presented to the dermatology clinic with a two-week history of purpuric skin lesions following symptoms of sore throat, rhinorrhea, and malaise. He was not taking any medications and was not known for any allergies. His review of systems was notable for abdominal pain and arthralgias of the ankles and knees. On physical exam, palpable purpura extending from the feet to the mid-thighs were noted bilaterally. Additional workup revealed microscopic hematuria and mild proteinuria. The remainder of his workup was normal. A biopsy of a purpuric papule showed findings characteristic of the diagnosis on H&E, and direct immunofluorescence demonstrated perivascular IgA and C3 positivity.

1. What is the diagnosis and how should the biopsy ideally be performed?

2. What are the characteristic findings seen on H&E?

3. What are the extracutaneous manifestations that may be seen in association with this diagnosis?

4. What are a few conditions that are associated with this diagnosis?

5. How would you manage a patient with this diagnosis?

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