Small vessel leukocytoclastic vasculitis: Difference between revisions
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| Caption = Leukocytoclastic vasculitis. [[H&E stain]]. | | Caption = Leukocytoclastic vasculitis. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = leukocytoclastic vasculitis, hypersensitivity vasculitis | ||
| Micro = small vessels intramural inflammatory cells (neutrophils), vessel damage (fibrin deposition) | | Micro = small vessels intramural inflammatory cells (neutrophils), vessel damage (fibrin deposition) | ||
| Subtypes = | | Subtypes = | ||
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| Prognosis = dependent on underlying cause | | Prognosis = dependent on underlying cause | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = see ''etiology'' section | ||
| Tx = remove underlying cause; colchicine and/or dapsone; immunosuppression | | 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== | ==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> | *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/> | 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. | ||
==Gross== | |||
*Palpable purpura - raised lesions that can appreciated with touch, red/purple in colour. | |||
* | |||
==Microscopic== | ==Microscopic== | ||
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*#Neutrophils. | *#Neutrophils. | ||
*#*Fragmentation of [[neutrophil]]s (leukocytoclasia). | *#*Fragmentation of [[neutrophil]]s (leukocytoclasia). | ||
*#Vessel damage: fibrin deposition (bright pink acellular stuff). | *#Vessel damage: fibrin deposition (bright pink acellular stuff) or "nuclear dust" (punctate hyperchromatic material). | ||
DDx: | DDx: | ||
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==Stains== | ==Stains== | ||
*[[PAS stain|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== | ||