Last week we discussed a young man with IBD, with recurrent episodes of palpable purpura. It was ultimately thought that he had a post-viral leukocytoclastic vasculitis.
Palpable purpura is a rare finding, but can be dramatic. It is important to recognize because it can be a harbinger of serious illness. Purpura is caused by necrosis, antigen-antibody complex deposition, and fibrin deposition on or between endothelial cells. Although it is classically associated with cutaneous small-vessel vasculitis, as in this patient, it is also associated with embolic, infectious, and malignant causes.
Here is a general differential diagnosis (note vasculitidies comprise the bulk of the list):
Inflammatory
Cutaneous vasculitis
Hypersensitivity vasculitis (ie medications-induced)
Henoch-Schonlein purpura
Polyarteritis nodosa
Granulomatous vasculitis (Wegener's granulomatosis, Churg-Strauss vasculitis)
Cutaneous vasculitis associated with a collagen vascular disease (e.g., systemic lupus erythematosus, rheumatoid arthritis)
Giant cell arteritis
Mixed cryoglobulinemia
Hyperglobulinemic purpura
Infectious
Subacute bacterial endocarditis
Meningococcemia (usually petechial)
Noninflammatory
Trauma
Amyloidosis
Senile purpura
Scurvy
Sweet’s syndrome
Kaposi’s sarcoma
Toxins
Unfortunately not available online, here is the reference: Am Fam Physician. 1995 Oct;52(5):1355-62.
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