Case narrative:
55-year-old female with a past medical history of diabetes mellitus (DM) and hyperlipidemia (HLD) presented to the emergency department (ED) with a painful and pruritic rash localized in the abdomen and lower extremities that started two weeks prior. The patient was started on statin medication for managing HLD by her primary care doctor one week before the pruritic rash began. She denied smoking, alcohol, or drug use.
Vital signs were blood pressure 135/86 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, temperature 97.9 F, and oxygen saturation 98% on room air.
Physical examination was remarkable for multiple non-blanching raised violaceous papules tender to palpation coalescing in certain areas in the lower extremities and less quantity in the lower abdomen. (Image 1) Initial blood work that included ANCA with subtypes and hepatitis panel was unremarkable except for elevation of complement C3 (Table 1).
The patient underwent a punch biopsy that reported leukocytoclastic vasculitis [Image 2-3]; immunofluorescence did not show up any deposition. Statin was immediately discontinued, and she was started on a 5-day course of PO prednisone and a 2-week course of antihistaminics with famotidine, hydroxyzine, along with triamcinolone ointment with a complete resolution of the lesion within the next 15 days. Diagnosis of leukocytoclastic vasculitis in the setting of drug use (statin) was made.
The patient is currently following in an outpatient clinic with rheumatology and dermatology without recurrence of the disease or systemic signs/symptoms.