Small vessel leukocytoclastic vasculitis
Small vessel leukocytoclastic vasculitis, also leukocytoclastic vasculitis (abbreviated LCV) and hypersensitivity vasculitis,[1] is an inflammatory process of the small blood vessel.
| 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 |
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.
- ANCA mediated vasculitides:
- 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:
- Neutrophils.
- Fragmentation of neutrophils (leukocytoclasia).
- Vessel damage: fibrin deposition (bright pink acellular stuff) or "nuclear dust" (punctate hyperchromatic material).
- Neutrophils.
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
- ↑ 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.