Acute lymphoblastic leukemia (ALL) is a hematologic
cancer that begins in the bone marrow and results in an overproduction of lymphocytes. It can present as palpable
purpura, which is also seen in many other pathologies, including vasculitides such as
IgA vasculitis. We present a case of a 52-year-old male who presented to our hospital from an outside facility specifically for plasma exchange for treating a previously diagnosed
IgA vasculitis. After being admitted for further evaluation, it was noted that the patient had a diffuse petechial non-blanching purpuric
rash bilaterally covering the lower extremities, trunk, upper extremities, and tongue. The patient was also noted to have severe
pancytopenia. Fluorescence in situ hybridization (FISH) demonstrated the presence of t(9:22), indicating
Philadelphia chromosome rearrangement. The patient was diagnosed with ALL. The patient underwent
induction chemotherapy and was continued on
hyper-CVAD protocol with intrathecal
chemotherapy. The patient appeared to respond well to treatment and is currently undergoing subsequent intermittent
chemotherapy. In this case, the diagnosis of B-cell ALL (B-ALL)
blast crisis was pivotal in providing the correct
therapy to this patient, and the case demonstrated that even rare presentations of B-ALL in this population with rare mutations responds avidly to
tyrosine kinase inhibitors.