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Case Reports in Rheumatology
Volume 2016, Article ID 4829459, 3 pages
http://dx.doi.org/10.1155/2016/4829459
Case Report

Skin Findings in a Patient with Sjogren’s Syndrome

1Advocate Illinois Masonic Medical Center, Department of Internal Medicine, 856 West Nelson Street, Apt No. 2002, Chicago, IL 60657, USA
2Advocate Illinois Masonic Medical Center, Department of Internal Medicine, 2356 North Elston Avenue, No. 306, Chicago, IL 60614, USA
3RUSH University Medical Center, Department of Rheumatology, 1725 West Harrison Street, Chicago, IL 60612, USA

Received 23 July 2016; Accepted 24 August 2016

Academic Editor: Mehmet Soy

Copyright © 2016 Prajwal Boddu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.