Clozapine is the most effective drug for treatment-resistant schizophrenia (TRS) but is associated with several adverse effects, including rare immune-mediated reactions. Cutaneous small vessel vasculitis (CSVV), also known as leukocytoclastic vasculitis, is an uncommon complication that typically presents as palpable purpura involving dependent areas of the body. We describe a case of a 22-year-old male patient with TRS who developed a painful, non-blanching purpuric, papular rash over both lower limbs two weeks after initiation and dose escalation of clozapine. Laboratory evaluation showed mild leukocytosis with eosinophilia, while renal, hepatic, infectious, and immunological investigations were normal, and there was no evidence of systemic involvement. In view of the clear temporal association with clozapine initiation and absence of alternative causes, a diagnosis of drug-induced CSVV was made. Clozapine was discontinued, and the patient was transitioned to quetiapine for ongoing psychiatric management. The vasculitic lesions were managed with systemic corticosteroids, antihistamines, pentoxifylline, and supportive measures, resulting in marked improvement within two weeks and complete resolution over six weeks without recurrence. Causality assessment using the Naranjo adverse drug reaction probability scale gave a score of 6, suggestive of a probable association with clozapine. Rechallenge was avoided due to the risk of recurrence. This case emphasizes the need for clinicians to recognize rare immune-mediated cutaneous reactions associated with clozapine. Early recognition and prompt discontinuation of the offending agent are essential to prevent progression and ensure favorable outcomes.

IgA vasculitis (IgAV) and IgA nephropathy (IgAN) are increasingly recognized as part of a disease spectrum sharing common pathogenic mechanisms involving galactose-deficient IgA1. While IgAN represents kidney-limited disease, IgAV is the systemic manifestation. The development of systemic IgA vasculitis in patients with established end-stage renal disease (ESRD) secondary to IgA nephropathy is rarely reported and presents unique diagnostic challenges. We present a case of a 51-year-old woman with ESRD secondary to IgA nephropathy on maintenance hemodialysis who presented with acute anemia, abdominal pain, arthralgias, and gastrointestinal bleeding. On hospital day three, she developed palpable purpura on the bilateral lower extremities. Skin biopsy demonstrated leukocytoclastic vasculitis with perivascular IgA, IgM, and C3 deposition on direct immunofluorescence, confirming IgA vasculitis. Treatment with high-dose systemic corticosteroids resulted in the resolution of cutaneous and systemic manifestations. This case highlights the diagnostic complexity of adult IgA vasculitis in ESRD patients with underlying IgA nephropathy, where symptoms may mimic common dialysis-related complications. Recognition of the shared pathophysiology between IgAN and IgAV is essential for appropriate diagnosis and management.

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical-Etiological-Anatomical-Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes.

Immunoglobulin A vasculitis (IgAV), formerly Henoch-Schönlein purpura, is the most common systemic vasculitis of childhood and is typically self-limited. Renal risk stratification frequently relies on the presence of hematuria or proteinuria; however, early disease severity may not be detected by urinalysis alone. We present a previously healthy seven-year-old boy with palpable purpura and joint pain. The diagnosis was made clinically based on the presence of nonthrombocytopenic palpable purpura in the setting of arthralgia. He was diagnosed with IgAV after initially reassuring laboratory findings, including normal renal function and repeatedly negative urinalysis. Despite this, his clinical course rapidly progressed to persistent vomiting, abdominal pain, gastrointestinal bleeding, scrotal edema, and sustained hypertension requiring hospitalization and pharmacologic management. Repeated urinalyses during the acute illness remained negative for hematuria and proteinuria despite the development of hypertension and severe systemic involvement. This case highlights a clinical pitfall: although IgAV is primarily a clinical diagnosis based on characteristic findings such as palpable purpura and systemic symptoms, early laboratory studies, including urinalysis, may appear reassuring despite evolving systemic involvement. Close follow-up with serial blood pressure monitoring and urinalysis is essential during the disease course, whether initial laboratory findings are reassuring or abnormal.

We present the case of a 60-year-old man with granulomatosis with polyangiitis (GPA). While he initially presented with only renal involvement, he developed cutaneous manifestations more than a decade later. Cutaneous manifestations may manifest at any point during the duration of the disease, although most usually present at the onset. Cutaneous manifestations of GPA include petechial-like lesions and palpable purpura, typical of what is seen with small vessel vasculitides, as well as pyoderma gangrenosum (PG)-like lesions, digital necrosis, subcutaneous nodules, and/or livedo, which can also be seen but may be more commonly associated with medium vasculitis. As these manifestations may also be found in tandem with other diseases, it is important to include GPA as part of the differential diagnosis when such skin lesions are identified. Treatment of cutaneous manifestations of GPA includes glucocorticoids and immunosuppressive agents.

BACKGROUND Dalbavancin is a lipoglycopeptide antibiotic largely used to treat serious and complex bacterial infections, particularly those caused by gram-positive bacteria. Its main advantages include a prolonged half-life, which allows for once-weekly dosing, effectiveness against resistant pathogens, most notably, methicillin-resistant Staphylococcus aureus, and a good profile of tolerability and patient adherence. Herein we report the first documented case of a patient who developed palpable purpura on both lower limbs following treatment with dalbavancin, which was clinically and histologically diagnosed as leukocytoclastic vasculitis (LV). CASE REPORT A 66-year-old woman received dalbavancin due to an acute bacterial skin and skin structure infection (ABSSSI) of her right leg. The patient initially showed a favorable clinical response, with marked improvement of the infection. However, 3 weeks after the administration of dalbavancin, she developed a diffuse erythematous palpable purpura, predominantly affecting the lower limbs, and accompanied by mild arthralgia and generalized asthenia. To further investigate and confirm the underlying cause of these new symptoms, a skin biopsy was performed, revealing histopathological findings consistent with LV. Following the diagnosis, corticosteroid therapy was initiated, resulting in a significant symptomatic improvement. CONCLUSIONS To the best of our knowledge, this is the first published, histologically confirmed case report of LV developing after treatment with dalbavancin. Given the widespread use of dalbavancin for treating ABSSSIs, clinicians should be aware of the potential adverse effects, including LV, that may arise during its administration.

Parvovirus B19 (B19V) is a common viral agent that may cause arthritis in adults. In rare cases, B19V has been associated with cryoglobulinaemic vasculitis. We report the case of a 47-year-old woman who presented with an acute febrile polyarthritis and palpable purpura on the lower limbs. Laboratory investigations revealed low complement C4, positive IgM and IgG for Parvovirus B19, and detectable serum cryoglobulins, which immunofixation was consistent with type III cryoglobulinemia. The patient responded favourably to corticosteroid therapy, with complete resolution of symptoms. One month after premature discontinuation of steroids, she experienced a relapse of polyarthralgia. A second course of low-dose corticosteroids led to sustained remission, without further relapse. In order to understand the clinical features of B19V-associated cryoglobulinaemic vasculitis, we conducted a narrative review of the literature using the PubMed database, in which we identified seven cases. The most frequent features included constitutional symptoms, cutaneous vasculitis, joint involvement and complement consumption. One previous case clearly identified type III cryoglobulinemia. These findings highlight the clinical heterogeneity of this entity and the importance of considering B19V in the differential diagnosis of small-vessel vasculitis with cryoglobulinemia, particularly in seronegative patients for hepatitis C and autoimmune diseases.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that can rarely be complicated by systemic immune phenomena. We report a 41-year-old woman with severe HS refractory to adalimumab who developed fever, palpable purpura, and renal involvement. Skin biopsy confirmed IgA leukocytoclastic vasculitis, and renal biopsy revealed IgA nephritis. She was treated with corticosteroids, rituximab, and surgery, but proteinuria persisted. Initiation of bimekizumab led to marked improvement of HS lesions and a significant reduction in proteinuria. Over more than one year of follow-up, she achieved sustained HS control without recurrence of vasculitis or treatment-related adverse events. This case highlights the potential role of dual IL-17A/F inhibition in managing refractory HS complicated by IgA vasculitis and nephritis.

Background and Clinical Significance: Henoch-Schönlein purpura (HSP), also known as Immunoglobulin A (IgA) vasculitis (IgAV), is a common systemic vasculitis in children characterized by palpable purpura, abdominal pain, and joint and kidney involvement. While respiratory tract viral or bacterial infections are the most common causes of HSP, parasitic infections, such as giardiasis, are occasionally reported. Giardia lamblia is the most common parasite infecting humans and a major cause of infectious diarrhea, which can lead to post-infection complications. To our knowledge, this is the first report in Greece describing a pediatric patient with HSP secondary to giardiasis. A review of pediatric HSP cases caused by parasitic infections is also included. Case presentation: An 8-year-old girl presented with a purpuric rash, joint tenderness, severe abdominal pain, and bloody diarrhea, raising suspicion of HSP. Laboratory tests revealed elevated IgA levels, and stool analysis tested positive for Giardia lamblia antigen. The diagnosis of HSP secondary to giardiasis was confirmed, and the patient was successfully treated with supportive care, metronidazole, and corticosteroids. Conclusion: This case report and literature review highlight parasitic infections as an underrecognized but important trigger of pediatric HSP. Although giardiasis is linked to various post-infectious complications, its association with HSP is rarely reported. Pediatricians should maintain a high level of suspicion for underlying infectious diarrhea, such as giardiasis, in patients with HSP, especially in children with prominent gastrointestinal symptoms. Early recognition can reduce complications and facilitate faster recovery. Further research is needed for the immunopathogenic mechanisms linking parasitic infections and HSP in children.

The increasing number of reports from various parts of the world regarding Covid-19 vaccine-related cutaneous events has led to growing concerns about identifying the adverse cutaneous reactions among vaccinated individuals in Bangladesh. The study aimed to characterize the spectrum of cutaneous outcomes following SARS-CoV-2 vaccination and to assess their association with the types and doses of vaccine. From November 2021 to April 2022, a prospective observational study was conducted at the Kuwait Bangladesh Friendship Government Hospital in Dhaka, involving 252 subjects who reported cutaneous reactions within six weeks following Covid-19 vaccination. Data were collected through face-to-face interviews, physical examination and laboratory investigations by using a pre-tested questionnaire. Data were entered in SPSS 26.0. Descriptive analysis and association of variables were seen by frequency distribution and Chi-square analysis with a p-value less than or equal to 0.05. The average age of the study participants was 33.89±14.61 years, 51.2% were male and 48.8% were female. Most cutaneous reactions were observed among those who were vaccinated with Moderna (54.8%). The average gap between vaccination and onset of cutaneous eruption was 10.52±7.67 days. The cutaneous reactions mostly followed the booster dose. The nine cutaneous outcomes were generalized pruritus, urticaria, morbilliform eruption, the flare of dermatophyte infection, palpable purpura, local injection-site reaction, chilblain-like reaction, herpes zoster and diffuse hair loss. Generalized pruritus and urticaria were significantly associated with the booster dose, whereas morbilliform eruption was associated with the first and second doses. Cutaneous reactions found in this study were not severe and cured completely within a few days following symptomatic management.

Coumarin derivatives, including warfarin and acenocoumarol, are widely used oral anticoagulants that inhibit vitamin K-dependent coagulation factors. They are commonly prescribed for the prophylaxis of thromboembolic disorders. Although effective, these agents are associated with many adverse drug reactions, which include hemorrhagic complications, warfarin-induced skin necrosis, hypersensitivity reactions, and, rarely, leukocytoclastic vasculitis (LCV). LCV is an immune-mediated small-vessel vasculitis characterised by palpable purpura, often triggered by drugs, infections, or autoimmune conditions. Here, we present the case of a 53-year-old female with a history of rheumatic heart disease and mechanical mitral valve replacement who developed LCV after 5 years on acenocoumarol. The reaction persisted despite adjunct therapy and worsened upon switching to warfarin, suggesting possible cross-reactivity between these coumarin derivatives. Ultimately, transitioning to apixaban led to the complete resolution of symptoms. This case underscores the importance of early recognition of drug-induced vasculitis and highlights the need for individualised anticoagulation strategies in patients with hypersensitivity reactions.