Table 1

Summary of patient’s investigations

Inflammatory and autoimmune markers
ANCANegative
ANA-immunofluorescence<80
Anti-ds-DNA<25 (0–25 IU/mL)
CryoglobulinNegative
Complement 3 (C3)1.74 elevated than reference range (0.80–1.60 g/L)
Complement 4 (C4)0.41 (0.17–0.60 g/L)
Anti-HBc, TotalNon-reactive
HBsAgNon-reactive
Anti-HCVNon-reactive
Erythrocyte sedimentation rate (ESR)48 elevated (3–15 mm/hour)
C reactive protein (CRP)10.7 elevated (0–5 mg/L)
Full blood count
White blood cell10.2 high (4–9.6×109 /L)
Haemoglobin122 (118–146 g/L)
Platelets338 (150–360×109/L)
Absolute neutrophils7.42 elevated (1.90–6.6×109 /L)
Absolute lymphocytes2.04 (1.10–3.10×109 /L)
Absolute monocytes0.56 (0.20–0.70×109 /L)
Absolute eosinophils0.05 (0.00–0.60×109 /L)
Absolute basophils0.08 (0.00–0.10×109 /L)
Coagulation panel
APTT31.4 s
PT13.9 s
INR1.1
Urine protein and creatinine ratio
Total protein on admission0.3 U
Creatinine admission18.1 U
Prot:crea ratio on admission14
Urine microscopy
WBC, urine on admission>225 (0–6 cells/µL)
RBC, urine on admission18 (0–13 cells/µL)
Histopathology
Punch biopsy of skin to the subcutis. The stratum corneum is basketweave. The epidermis is unremarkable. There is a superficial and deep perivascular infiltrate of lymphocytes with many eutrophils. There is nuclear dust and red cell extravasation. Fibrin exudation is seen around some upper dermal blood vessels. This is in keeping with the diagnosis of leukocytoclastic vasculitis.
Direct immunofluorescence
IgMNegative
IgGNegative
C3Negative
FibrinogenNegative