A 73-year-old male presented with skin rash, ankle pain, weight loss, abdominal pain, non-bloody diarrhea, and testicular pain.On examination, he was afebrile and normotensive. He had palpable purpura over the legs (Fig. 1A), tenderness and swelling in ankle joints, and diffuse tenderness in the abdomen and scrotum.He denied recent infection or vaccination, new medications, or recreational drug use.Age-appropriate malignancy screening was negative. Laboratory evaluation revealed normal blood counts, creatinine, and complement (C3/C4) levels. Acute hepatitis, rheumatoid factor, antinuclear, antineutrophil cytoplasmic, and cryoglobulin antibodies were negative. He had elevated C-reactive protein (12.3 mg/dL), erythrocyte sedimentation rate (100 mm/h), and IgA level (900 mg/dL, normal range 70-400 mg/dL). Infectious fecal studies were negative. Urinalysis with microscopic examination showed hematuria, proteinuria, and red blood cell casts (Fig. 1B).Scrotal sonogram showed a large hypoechoic area in the right testis with absent blood flow concerning infarction (Fig. 1C). Magnetic resonance enterography revealed wall * Kinanah Yaseen
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