Small vessel leukocytoclastic vasculitis

Small vessel leukocytoclastic vasculitis, also leukocytoclastic vasculitis (abbreviated LCV), is an inflammatory process of the small blood vessel.

Small vessel leukocytoclastic vasculitis
Diagnosis in short
Leukocytoclastic vasculitis. H&E stain.
Synonyms	leukocytoclastic 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

General

• Most common cutaneous vasculitis.

Clinical:

• Palpable purpura, usu. lower extremity.

Treatment - dependent on cause - may include:

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

Etiology

Has a very broad DDx:

1. Infectious:
   • Bacterial.
   • Viral.
   • Fungal.
2. Vasculitic disorders:
   • ANCA mediated vasculitides:
     • Granulomatosis with polyangiitis (Wegener granulomatosis).
     • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).
   • Henoch–Schönlein purpura.
   • Urticarial vasculitis.
3. 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:

• 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

• LCA (ancavasculitis.com).
• LCA of the GI tract - several images (upmc.edu).

Stains

• PAS - look for fungus.

Sign out

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

• Vasculitides.
• Inflammatory skin disorders.