The Rash That Didn’t Blanch: A Case Report of Adult-Onset IgA Vasculitis with Underlying Cirrhosis and IgA Nephropathy

Rashes are a common presentation in the emergency department (ED) and can signify a wide variety of underlying conditions. Early recognition of serious dermatologic rashes in the acute care setting is essential in improving patient outcomes. Here we describe the case of a 69-year-old female with a medical history of cirrhosis with ascites, chronic kidney disease (CKD) secondary to immunoglobulin A (IgA) nephropathy, and hypertension who presented to the ED with a chief complaint of foot pain with an associated rash. On examination, she had tender purpura with bilateral symmetric pedal edema. Initial work up in the ED was significant for mildly elevated inflammatory markers. Given the concern for vasculitis, dermatology was consulted; punch biopsy confirmed IgA vasculitis. The patient was subsequently admitted for acute renal injury and started on corticosteroids. After a week-long inpatient stay, she was discharged home in stable condition. This case highlights the importance of maintaining a broad differential diagnosis for purpuric rashes, recognizing when specialty consultation is warranted, and understanding the pathophysiologic interplay between IgA vasculitis, liver cirrhosis, and IgA nephropathy. Topics: Vasculitis, IgA vasculitis, Henoch-Schönlein purpura, IgA nephropathy, dermatology.