Tumor necrosis factor (TNF) inhibitors are widely used biologics in the management of rheumatoid arthritis (RA), but they can occasionally induce paradoxical inflammatory manifestations. We present a case of a 28-year-old female patient with well-controlled rheumatoid arthritis who developed leukocytoclastic vasculitis (LCV) secondary to infliximab therapy. Despite initial treatment with alternative biologics and corticosteroids, her condition required escalation to rituximab therapy. Histopathological examination confirmed leukocytoclastic vasculitis involving vessels in the deep dermis. After 10 months of rituximab treatment, the patient experienced complete resolution of the vasculitis. This case highlights the importance of recognizing rare but significant cutaneous adverse effects of TNF inhibitors and illustrates the challenges in management when conventional therapy proves ineffective. Clinicians should maintain vigilance for paradoxical inflammatory responses when treating patients with biologic agents and consider appropriate therapeutic alternatives when such complications arise.