With a wide variety of associated diseases, proper diagnosis and treatment of annular rashes can prove clinically challenging. It is essential to remain vigilant of atypical presentations of disease and to complete a comprehensive history, physical, and workup to ensure optimal patient care.

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Introduction: With a wide variety of associated diseases, proper diagnosis and treatment of annular rashes can prove clinically challenging. Case Report: A 53-year-old male presents with a painful, purpuric, annular eruption in addition to multiple risk factors for systemic diseases. An extensive in-patient work-up yielded a suspected diagnosis of IgA-vasculitis despite an atypical presentation. Conclusion: A differential diagnosis for an annular eruption may include cat scratch disease, DRESS syndrome, IgA-vasculitis, among multiple other causes. It is essential to remain vigilant of atypical presentations of disease and to complete a comprehensive history, physical, and workup to ensure optimal patient care.