Rheumatology Case 7

A 58 year-old woman with a history of Sjögren’s syndrome (SS) for the last 10 years presented to Rheumatology Clinic with a skin rash involving the lower extremities. Clinical examination revealed bilateral parotid gland enlargement and palpable purpura over the extensor surfaces of the lower extremities. Antinuclear antibodies (ANA) were 1/1280 with a fine speckled pattern, IgM rheumatoid factor (RF) was 1/320 and antibodies to Ro (SSA) and La (SSB) were also positive. The differential diagnosis for the palpable purpura in this patient comprises:
1. Hypergammaglobulinemic purpura
2. Idiopathic thrombocytopenic purpura  
3. Waldenström macroglobulinemia  
4. T-cell lymphoma  





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