Difference between revisions of "Small vessel leukocytoclastic vasculitis"

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#redirect [[Vasculitides#Small_vessel_leukocytoclastic_vasculitis]]
{{ 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]]

Latest revision as of 16:56, 3 January 2019

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

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]

  1. Infectious:
  2. Vasculitic disorders:
  3. Other:

Gross

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

Microscopic

Features:[2]

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

DDx:

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.

See also

References

  1. ↑ Einhorn, J.; Levis, JT. (2015). "Dermatologic Diagnosis: Leukocytoclastic Vasculitis.". Perm J 19 (3): 77-8. doi:10.7812/TPP/15-001. PMID 26176572.
  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.
  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.
  4. ↑ Kraft, DM.; Mckee, D.; Scott, C. (Aug 1998). "Henoch-Schönlein purpura: a review.". Am Fam Physician 58 (2): 405-8, 411. PMID 9713395.
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