Palpable purpura: is it associated with vasculitis or not? A single-center experience

Clin Rheumatol. 2022 May;41(5):1493-1498. doi: 10.1007/s10067-022-06075-5. Epub 2022 Jan 25.

Abstract

Background and aim: The most common cutaneous manifestation of small vessel vasculitis is palpable purpura. Etiology includes various causes such as infections, malignancies, drugs, and systemic vasculitides. The number of studies that evaluated the etiology of patients presenting with palpable purpura in the adult age group is minimal. This study aimed to determine the etiology in patients presenting with palpable purpura and analyze the clinical features associated with this pathology.

Materials and methods: We included 85 patients over 18 years old who presented with palpable purpura in the study. The presenting demographic characteristics, medical history, systemic examination findings, laboratory, imaging, and histopathological results, and initial treatment of the patients were recorded. At the end of data collection, statistical analyses were performed to determine the patients' final diagnoses and organ involvement.

Results: Etiological evaluation revealed Ig A vasculitis (IgAV) in 58.8% (n = 50) of the cases, cutaneous leukocytoclastic vasculitis (CLV) in 23.5% (n = 20), and ANCA-associated vasculitis (AAV) in 3.5% (n = 3). Rheumatologic disease-associated vasculitis (RDaV) was detected in 7.1% (n = 6) of the patients. In 7.1% (n = 6) of the patients, the biopsy results were not compatible with vasculitis (NVH).

Discussion: Palpable purpura can occur due to many reasons. Ig A vasculitis was the most common cause of palpable purpura in our study.

Key points: • All clinicians should recognize and know palpable purpura and its differential diagnosis. • IgA vasculitis is the most common cause of palpable purpura in adult patients. • In our study, Anca-associated vasculitis (AAV) was found in 3 (3%) of 85 adult patients with palpable purpura.

Keywords: IgA vasculitis; Purpura; Small vessel; Vasculitis.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / complications
  • Humans
  • IgA Vasculitis* / complications
  • IgA Vasculitis* / diagnosis
  • Purpura* / etiology
  • Vasculitis, Leukocytoclastic, Cutaneous* / complications
  • Vasculitis, Leukocytoclastic, Cutaneous* / diagnosis
  • Vasculitis, Leukocytoclastic, Cutaneous* / therapy

Supplementary concepts

  • Vascular purpura