Small Vessel Vasculitis from Mycoplasma Infection and Concurrent Topical Nonsteroidal Anti-Inflammatory Drug (NSAID) Medication

Vasculitis is characterized by inflammation of blood vessels, and can manifest as characteristic skin rashes and, in severe cases, lead to end-organ damage. Causes of vasculitis include autoimmune conditions, infections, and allergens.

We describe a 63-year-old woman who presented to the Emergency Department with petechiae, ecchymosis, and purpura after topical diclofenac application, initially diagnosed with a hypersensitivity vasculitis. Further investigation revealed a case of mycoplasma-induced IgA vasculitis that required several months of multidisciplinary care to treat and resolve. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of a broad differential and workup in cases of suspected vasculitis. Any rash with petechiae and purpura may indicate underlying vasculitis. Early investigation into causes of vasculitis, including infection, hypersensitivity, and autoimmune conditions, as well as signs of end-organ damage are crucial to initiate proper treatment and prevent further complications.