Skin Findings in a Patient with Sjogren's Syndrome.
Hypergammaglobulinemic purpura (HGP) is a syndrome constellating recurrent purpura, hypergammaglobulinemia, positive rheumatoid factor (RF), anti-Ro/La antibodies, and elevated erythrocyte sedimentation rate (ESR). We present a case of a 29-year-old female who was diagnosed with Sjogren's syndrome four years prior to presenting with rash on her lower extremities for a period of 6 months. Skin biopsy at the initial visit was consistent with leukocytoclastic vasculitis and was initiated on treatment for it. Her rash evolved into 2-5 mm scattered purpurae while she was on the treatment and a repeat biopsy showed extravasation of RBCs, a sparse mononuclear infiltrate with deposition of plasma cells, and no evidence of leukocytoclastic vasculitis, thus showing a transition from neutrophilic to mononuclear inflammatory vascular disease which is a rare occurrence. Hypergammaglobulinemic purpura sometimes turns out to be a challenging disease to manage and requires an integrated effort from the primary care doctors, rheumatologist, and dermatologist.
Advocate Illinois Masonic Medical Center, Department of Internal Medicine, 856 West Nelson Street, Apt No. 2002, Chicago, IL 60657, USA.
Prajwal
0000-0003-4594-1704
P
Boddu
Advocate Illinois Masonic Medical Center, Department of Internal Medicine, 2356 North Elston Avenue, No. 306, Chicago, IL 60614, USA.
Abdul S
0000-0003-1061-0497
AS
Mohammed
RUSH University Medical Center, Department of Rheumatology, 1725 West Harrison Street, Chicago, IL 60612, USA.
Sonali
S
Khandelwal
Medicine (Baltimore). 1992 Nov;71(6):386-401; discussion 401-3
1435231
Clin Exp Rheumatol. 2004 Sep-Oct;22(5):632-6
15485020
Arthritis Rheum. 1985 Nov;28(11):1251-8
3877510
Clin Rheumatol. 2004 Apr;23(2):170-1
15045635
J Rheumatol. 1995 May;22(5):868-75
8587074
J Dermatol. 1995 Mar;22(3):186-90
7738274
Clin Rheumatol. 1984 Jun;3(2):263-6
6236022
Scand J Rheumatol Suppl. 1986;61:139-41
3473622
Scand J Rheumatol. 2015;44(1):36-41
25268749
Clin Exp Rheumatol. 2004 Jan-Feb;22(1):55-62
15005005
J Invest Dermatol. 1976 Jun;66(6):344-50
6597