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

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, 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.

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