IgA Vasculitis Secondary to Enterococcus Faecalis Cardiac Device Infective Endocarditis; A Case Report, Discussion of the Literature and Protocol for Assessment of Inflammatory Skin Lesions in Emergency Medicine

A 68-year-old Caucasian male presented to the emergency department for administration of IV ceftriaxone post discharge for Enterococcus faecalis Cardiac Device Infective Endocarditis (CDIE). The patient reported a rash on his legs which had been present for many weeks. On examination the rash a revealed non-blanching purpuric rash resembling leukocytoclastic vasculitis. Biopsy and serology performed in our rural emergency department confirmed IgA vasculitis (IgAV). The patient had no systemic features to suggest IgA nephritis, or other systemic disease and the rash resolved with no additional treatment. A discussion of the differential diagnoses in this case highlights the importance of opportunistic biopsy and vasculitis serology in the rural emergency department setting and recommends screening for underlying cancer given the close association of IgAV with malignancy. The importance of emergency department protocols for assessment of skin lesions suggestive of an underlying systemic disease is also discussed.