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The rash began on the feet and spread to the legs, buttocks, back, arms, and ears, progressing from blanching macules to nonblanching purpuric papules (see ). He also had conjunctival injection, oral lesions, unilateral cervical lymphadenopathy, and acral edema, and refused to walk. Laboratory evaluation revealed mild leukocytosis and elevated inflammatory markers. The main differential diagnoses were Kawasaki disease and IgA vasculitis; a skin biopsy confirmed the latter.
Comment
Although IgA vasculitis classically presents with palpable purpura of the leg, this case demonstrates that in practice the rash can be highly variable. My experience echoes this; I’ve seen cases with prominent wrist lesions and others with intensely pruritic…