Sjogren and Rash

A 58 year-old woman with a history of Sjögren’s syndrome (SS) for the last 10 years presented to Rheumatology Clinic with a skin rash involving in the lower extremities. She is very active and also had participated in the walk for Breast Cancer awareness recently. Clinical examination revealed bilateral parotid gland enlargement and palpable purpura over the extensor surfaces of the lower extremities. Antinuclear antibodies (ANA) were 1/1280 with a fine speckled pattern, IgM rheumatoid factor (RF) was 1/320 and antibodies to Ro (SSA) and La (SSB) were also positive
What is the most likely diagnosis?
A. Hypergammaglobulinemic purpura

B. Idiopathic thrombocytopenic purpura  

C. Waldenström macroglobulinemia 
 
D. T-cell lymphoma