Small vessel leukocytoclastic vasculitis

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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

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

General

  • Most common cutaneous vasculitis.[1]

Clinical:

  • Palpable purpura, usu. lower extremity.

Treatment - dependent on cause - may include:[2]

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

Etiology

Has a very broad DDx:[1]

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

Gross

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

Microscopic

Features:[1]

  • 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, 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. 1.0 1.1 1.2 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.
  2. 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.
  3. Kraft, DM.; Mckee, D.; Scott, C. (Aug 1998). "Henoch-Schönlein purpura: a review.". Am Fam Physician 58 (2): 405-8, 411. PMID 9713395.