Small vessel leukocytoclastic vasculitis

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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

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.