Small vessel leukocytoclastic vasculitis: Difference between revisions

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'''Small vessel leukocytoclastic vasculitis''', also '''leukocytoclastic vasculitis''' (abbreviated '''LCV'''), is an inflammatory process of the small [[blood vessel]].
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Leukocytoclastic vasculitis -- high mag.jpg
| Width      =
| Caption    = Leukocytoclastic vasculitis. [[H&E stain]].
| Synonyms  = leukocytoclastic vasculitis, hypersensitivity vasculitis
| Micro      = small vessels intramural inflammatory cells (neutrophils), vessel damage (fibrin deposition)
| Subtypes  =
| LMDDx      = [[dermatitides with perivascular inflammation]]
| Stains    = [[PAS stain|PAS]] -ve
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[blood vessels]] - see ''[[vasculitides]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = palpable purpura
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on underlying cause
| Other      =
| ClinDDx    = see ''etiology'' section
| Tx        = remove underlying cause; colchicine and/or dapsone; immunosuppression
}}
'''Small vessel leukocytoclastic vasculitis''', also '''leukocytoclastic vasculitis''' (abbreviated '''LCV''') and '''hypersensitivity vasculitis''',<ref name=pmid26176572>{{Cite journal  | last1 = Einhorn | first1 = J. | last2 = Levis | first2 = JT. | title = Dermatologic Diagnosis: Leukocytoclastic Vasculitis. | journal = Perm J | volume = 19 | issue = 3 | pages = 77-8 | month =  | year = 2015 | doi = 10.7812/TPP/15-001 | PMID = 26176572 }}</ref> is an inflammatory process of the small [[blood vessel]].


==General==
==General==
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*Palpable purpura, usu. lower extremity.
*Palpable purpura, usu. lower extremity.


==Microscopic==
Treatment - dependent on cause - may include:<ref name=pmid24756249>{{Cite journal  | last1 = Goeser | first1 = MR. | last2 = Laniosz | first2 = V. | last3 = Wetter | first3 = DA. | title = A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. | journal = Am J Clin Dermatol | volume = 15 | issue = 4 | pages = 299-306 | month = Aug | year = 2014 | doi = 10.1007/s40257-014-0076-6 | PMID = 24756249 }}</ref>
Features:<ref name=pmid18948765/>
*Remove underlying cause if it can be determined.
*Small upper dermis vessels with:
*Colchicine and/or dapsone.
*#Neutrophils.
*Immunosuppression.
*#*Fragmentation of neutrophils (leukocytoclasia).
*#Vessel damage: fibrin deposition (bright pink acellular stuff).


===Etiology===
Has a very broad DDx:<ref name=pmid18948765/>
Has a very broad DDx:<ref name=pmid18948765/>
#Infectious:
#Infectious:
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#Vasculitic disorders:
#Vasculitic disorders:
#*ANCA mediated vasculitides:
#*ANCA mediated vasculitides:
#**[[Wegener granulomatosis]].
#**[[Granulomatosis with polyangiitis]] (Wegener granulomatosis).
#**[[Churg-Strauss syndrome]].
#**[[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome).
#*[[Henoch–Schönlein purpura]].<ref name=pmid9713395>{{Cite journal  | last1 = Kraft | first1 = DM. | last2 = Mckee | first2 = D. | last3 = Scott | first3 = C. | title = Henoch-Schönlein purpura: a review. | journal = Am Fam Physician | volume = 58 | issue = 2 | pages = 405-8, 411 | month = Aug | year = 1998 | doi =  | PMID = 9713395 }}</ref>
#*[[Henoch–Schönlein purpura]].<ref name=pmid9713395>{{Cite journal  | last1 = Kraft | first1 = DM. | last2 = Mckee | first2 = D. | last3 = Scott | first3 = C. | title = Henoch-Schönlein purpura: a review. | journal = Am Fam Physician | volume = 58 | issue = 2 | pages = 405-8, 411 | month = Aug | year = 1998 | doi =  | PMID = 9713395 }}</ref>
#*Urticarial vasculitis.
#*Urticarial vasculitis.
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#*Drugs.
#*Drugs.


Image:
==Gross==
*Palpable purpura - raised lesions that can appreciated with touch, red/purple in colour.
 
==Microscopic==
Features:<ref name=pmid18948765/>
*Small upper dermis vessels with:
*#Neutrophils.
*#*Fragmentation of [[neutrophil]]s (leukocytoclasia).
*#Vessel damage: fibrin deposition (bright pink acellular stuff) or "nuclear dust" (punctate hyperchromatic material).
 
DDx:
*[[Dermatitides with perivascular inflammation]].
 
===Image===
====Case====
<gallery>
Image: Leukocytoclastic vasculitis -- very low mag.jpg | LCV - very low mag. (WC)
Image: Leukocytoclastic vasculitis -- low mag.jpg | LCV - low mag. (WC)
Image: Leukocytoclastic vasculitis -- intermed mag.jpg | LCV - intermed. mag. (WC)
Image: Leukocytoclastic vasculitis -- high mag.jpg | LCV - high mag. (WC)
Image: Leukocytoclastic vasculitis -- very high mag.jpg | LCV - very high mag. (WC)
</gallery>
====www====
*[http://www.ancavasculitis.com/biopsy.php LCA (ancavasculitis.com)].
*[http://www.ancavasculitis.com/biopsy.php LCA (ancavasculitis.com)].
*[http://path.upmc.edu/cases/case189.html LCA of the GI tract - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case189.html LCA of the GI tract - several images (upmc.edu)].


==Stains==
==Stains==
*PAS - look for fungus.
*[[PAS stain|PAS]] - look for fungus.
 
==Sign out==
<pre>
Skin, Left Outer Thigh, Punch Biopsy:
    - Hypersensitivity vasculitis (leukocytoclastic vasculitis).
</pre>
 
===Alternate===
<pre>
Skin, Right Leg, Punch Biopsy:
    - Leukocytoclastic vasculitis.
</pre>
 
===Micro===
The sections show red blood cells extravasation and nuclear dust. Scattered neutrophils are within the wall of small blood vessels.


==See also==
==See also==
*[[Vasculitides]].
*[[Vasculitides]].
*[[Inflammatory skin disorders]].


==References==
==References==
Retrieved from "https://librepathology.org/wiki/Small_vessel_leukocytoclastic_vasculitis"