Immunoglobulin A (IgA)-mediated vasculitis is a small-vessel vasculitis defined by IgA-dominant immune complex deposition. Although common in children, adult-onset cases are rare and may signal underlying malignancies. In this case report, we present a 60-year-old male with chronic lymphocytic leukemia (CLL) under observation for his painful purpura and non-healing leg ulcers, with a biopsy confirming IgA vasculitis. His course was further complicated by steroid-induced diabetes, poor wound healing, recurrent infections, and fatal respiratory failure. He remained steroid-dependent with recurrent ulcer flares on tapering and infections, including pneumonia and varicella-zoster. Flow cytometry revealed persistent clonal B-cell populations with stable lymphocyte counts, suggesting subclinical CLL-driven immune dysregulation. This case highlights adult-onset IgA vasculitis as a potential paraneoplastic clue of indolent CLL even in the absence of leukemia progression. It underscores the importance of early malignancy screening, coordinated multidisciplinary care, and early steroid-sparing therapy in adult vasculitis patients with atypical features.
Vemula et al. (2026) studied this question.