Annular and Purpuric Plaques with Systemic Symptoms: A Unique Presentation of Immunoglobulin A Vasculitis

A male in his 20s presented to the hospital with a rash, abdominal pain, blood in the stool, and fatigue. The rash, originally diagnosed as urticarial vasculitis, developed 4 months prior and had been treated with several courses of low-dose steroids without resolution. Physical examination revealed erythematous plaques with older lesions in a generalized distribution across the face, trunk, and extremities. Laboratory workup revealed an elevated C-reactive protein and total complement. Histopathology revealed a leukocytoclastic vasculitis, and direct immunofluorescence confirmed the diagnosis of immunoglobulin A (IgA) vasculitis. His clinical course improved with intravenous corticosteroids, and the patient was discharged home on a prednisone taper. We present a cutaneous manifestation of this disease that differs from the typical palpable purpura associated with IgA vasculitis. This case highlights the importance of recognizing the diverse cutaneous morphology of IgA vasculitis and performing the appropriate work-up so that early diagnosis can be achieved and treatment can be promptly started.