Difference between revisions of "Small vessel leukocytoclastic vasculitis"

Small vessel leukocytoclastic vasculitis
	Diagnosis in short
	; Leukocytoclastic vasculitis. H&E stain.
Synonyms	leukocytoclastic vasculitis, hypersensitivity vasculitis
LM	small vessels intramural inflammatory cells (neutrophils), vessel damage (fibrin deposition)
LM DDx	dermatitides with perivascular inflammation
Stains	PAS -ve
Site	blood vessels - see vasculitides
Signs	palpable purpura
Prevalence	uncommon
Prognosis	dependent on underlying cause
Clin. DDx	see etiology section
Treatment	remove underlying cause; colchicine and/or dapsone; immunosuppression

Latest revision as of 16:56, 3 January 2019

Small vessel leukocytoclastic vasculitis, also leukocytoclastic vasculitis (abbreviated LCV) and hypersensitivity vasculitis,^[1] is an inflammatory process of the small blood vessel.

General

Most common cutaneous vasculitis.^[2]

Clinical:

Palpable purpura, usu. lower extremity.

Treatment - dependent on cause - may include:^[3]

Remove underlying cause if it can be determined.
Colchicine and/or dapsone.
Immunosuppression.

Etiology

Has a very broad DDx:^[2]

Infectious:
- Bacterial.
- Viral.
- Fungal.
Vasculitic disorders:
- ANCA mediated vasculitides:
  - Granulomatosis with polyangiitis (Wegener granulomatosis).
  - Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).
- Henoch–Schönlein purpura.^[4]
- Urticarial vasculitis.
Other:
- Connective tissue disease, e.g. mixed connective tissue disease, SLE, rheumatoid arthritis.
- Cryoglobulinemia - may be due to multiple myeloma, hepatitis C; have intravascular thrombi.
- Paraneoplastic.
- Drugs.

Gross

Palpable purpura - raised lesions that can appreciated with touch, red/purple in colour.

Microscopic

Features:^[2]

Small upper dermis vessels with:
1. Neutrophils.
  - Fragmentation of neutrophils (leukocytoclasia).
2. Vessel damage: fibrin deposition (bright pink acellular stuff) or "nuclear dust" (punctate hyperchromatic material).

DDx:

Dermatitides with perivascular inflammation.

Image

Case

LCV - very low mag. (WC)
LCV - low mag. (WC)
LCV - intermed. mag. (WC)
LCV - high mag. (WC)
LCV - very high mag. (WC)

www

Stains

PAS - look for fungus.

Sign out

Skin, Left Outer Thigh, Punch Biopsy:
     - Hypersensitivity vasculitis (leukocytoclastic vasculitis).

Alternate

Skin, Right Leg, Punch Biopsy:
     - Leukocytoclastic vasculitis.

Micro

The sections show red blood cells extravasation and nuclear dust. Scattered neutrophils are within the wall of small blood vessels.

References

↑ Einhorn, J.; Levis, JT. (2015). "Dermatologic Diagnosis: Leukocytoclastic Vasculitis.". Perm J 19 (3): 77-8. doi:10.7812/TPP/15-001. PMID 26176572.
↑ ^2.0 ^2.1 ^2.2 Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.
↑ Goeser, MR.; Laniosz, V.; Wetter, DA. (Aug 2014). "A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.". Am J Clin Dermatol 15 (4): 299-306. doi:10.1007/s40257-014-0076-6. PMID 24756249.
↑ Kraft, DM.; Mckee, D.; Scott, C. (Aug 1998). "Henoch-Schönlein purpura: a review.". Am Fam Physician 58 (2): 405-8, 411. PMID 9713395.

[pmid26176572-1] Einhorn, J.; Levis, JT. (2015). "Dermatologic Diagnosis: Leukocytoclastic Vasculitis.". Perm J 19 (3): 77-8. doi:10.7812/TPP/15-001. PMID 26176572.

[pmid18948765-2] 2.0 ^2.1 ^2.2 Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.

[pmid24756249-3] Goeser, MR.; Laniosz, V.; Wetter, DA. (Aug 2014). "A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.". Am J Clin Dermatol 15 (4): 299-306. doi:10.1007/s40257-014-0076-6. PMID 24756249.

[pmid9713395-4] Kraft, DM.; Mckee, D.; Scott, C. (Aug 1998). "Henoch-Schönlein purpura: a review.". Am Fam Physician 58 (2): 405-8, 411. PMID 9713395.

[1]

[2]

[3]

[4]

@@ Line 4: / Line 4: @@
 | Width      =
 | Caption    = Leukocytoclastic vasculitis. [[H&E stain]].
-| Synonyms   =
+| Synonyms   = leukocytoclastic vasculitis, hypersensitivity vasculitis
 | Micro      = small vessels intramural inflammatory cells (neutrophils), vessel damage (fibrin deposition)
 | Subtypes   =
@@ Line 27: / Line 27: @@
 | Prognosis  = dependent on underlying cause
 | Other      =
-| ClinDDx    =
+| ClinDDx    = see ''etiology'' section
-| Tx         =
+| Tx         = remove underlying cause; colchicine and/or dapsone; immunosuppression
 }}
-'''Small vessel leukocytoclastic vasculitis''', also '''leukocytoclastic vasculitis''' (abbreviated '''LCV'''), is an inflammatory process of the small [[blood vessel]].
+'''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==
@@ Line 38: / Line 38: @@
 *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 [[neutrophil]]s (leukocytoclasia).
-*#Vessel damage: fibrin deposition (bright pink acellular stuff).
+===Etiology===
 Has a very broad DDx:<ref name=pmid18948765/>
 #Infectious:
@@ Line 52: / Line 51: @@
 #Vasculitic disorders:
 #*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>
 #*Urticarial vasculitis.
@@ Line 61: / Line 60: @@
 #*Paraneoplastic.
 #*Drugs.
+==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:
@@ Line 80: / Line 89: @@
 ==Stains==
 *[[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==
 *[[Vasculitides]].
+*[[Inflammatory skin disorders]].
 ==References==