Small vessel leukocytoclastic vasculitis: Difference between revisions
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# | {{ 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== | |||
*Most common cutaneous vasculitis.<ref name=pmid18948765>{{Cite journal | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref> | |||
Clinical: | |||
*Palpable purpura, usu. lower extremity. | |||
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> | |||
*Remove underlying cause if it can be determined. | |||
*Colchicine and/or dapsone. | |||
*Immunosuppression. | |||
===Etiology=== | |||
Has a very broad DDx:<ref name=pmid18948765/> | |||
#Infectious: | |||
#*Bacterial. | |||
#*Viral. | |||
#*[[Fungal]]. | |||
#Vasculitic disorders: | |||
#*ANCA mediated vasculitides: | |||
#**[[Granulomatosis with polyangiitis]] (Wegener granulomatosis). | |||
#**[[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. | |||
#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:<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://path.upmc.edu/cases/case189.html LCA of the GI tract - several images (upmc.edu)]. | |||
==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== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | |||
[[Category:Vasculitides]] | |||