Granulomatous pigmented purpuric dermatosis (PPD) is a rare subtype of pigmented purpuric dermatosis that is typically seen in women of Far East Asian descent on the distal lower extremities and feet. Granulomatous PPD is a benign condition that does not typically require treatment. Hyperlipidemia has been seen in over half of the eighteen cases reported in the literature. We report an unusual presentation of granulomatous PPD seen in a 71 year-old Caucasian female with hyperlipidemia.

Purpura annularis telangiectodes (PAT), also known as Majocchi purpura, is a rare form of pigmented purpuric dermatosis characterized by non-palpable red-brown, occasionally pruritic patches which progress to hyperpigmented halos. Purpura annularis telangiectodes usually presents in female adolescents as benign symmetric lesions with a predilection for the lower extremities. We present an atypical case of unilateral PAT in an elderly male. To our knowledge, our patient at 85-years-old is the oldest PAT and first unilateral purpura annularis telangiectodes case described in the literature.

Lichen nitidus typically presents as shiny pin-head sized papules on the trunk and extremities, often affecting children and young adults. In this prototypical form, it rarely presents a diagnostic challenge being characterized by distinctive clinical and histopathologic findings. We describe a rare variant of lichen nitidus, which we term “hyperkeratotic and hypertrophic lichen nitidus."

Introduction: Medication-induced leukocytoclastic vasculitis is a small-vessel vasculitis that most commonly manifests with palpable purpuric lesions on gravity dependent areas. Development of the vasculitis occurs within weeks after the initial administration of the medication, with clearance upon withdrawal of the medication. Glyburide, a sulfonylurea medication, is used to treat non-insulin dependent diabetes mellitus. We report a rare case of glyburide-associated leukocytoclastic vasculitis.

Observation: We report a 71-year-old man with type 2 diabetes mellitus who presented with palpable purpura on the lower extremities. Cutaneous biopsy revealed superficial small vessel vasculitis with IgA perivascular deposits.  Further questioning revealed three prior episodes of palpable purpura after restarting the glyburide medication, with clearance upon discontinuation. We diagnosed drug-induced vasculitis related to the glyburide.

Conclusions: This case highlights a rarely reported cutaneous adverse reaction to the commonly used diabetic medication, glyburide. Physicians should consider cutaneous vasculitis as a potential side effect of glyburide.

Abbreviations: LCV (Leukocytoclastic vasculitis), c-ANCA (centrally accentuated anti-neutrophilic cytoplasmic antibody), p-ANCA (Perinuclear anti-neutrophilic cytoplasmic antibody), anti-TNF-alpha (anti-tumor necrosis factor alpha)