A 57-year-old woman who had a history of osteoarthritis presented with a nonpruritic rash associated with paresthesia, myalgia, and worsening joint pain. The rash began on the soles of her feet and ascended toward her trunk. Her symptoms began 48 hours after starting atorvastatin and empagliflozin (Jardiance) for metabolic syndrome.

Examination revealed tender, nonblanching, palpable purpura extending from the bilateral lower extremities to the proximal thigh (Figure 1). A complete blood count, comprehensive metabolic panel, antinuclear antibody panel, and antineutrophil cytoplasmic antibody test were all unremarkable. Urinalysis was significant for proteinuria and hematuria. Punch biopsy of a lesion showed a predominantly neutrophilic infiltrate in the dermis with fibrinoid necrosis of wall vessels.

The patient later presented to the emergency department with acute abdominal pain; computed tomography showed inflammation of the terminal ileum.

Question

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Cutaneous small vessel vasculitis.

• B. Eosinophilic granulomatosis with polyangiitis.

• C. Immunoglobulin A vasculitis.

• D. Polyarteritis nodosa.