Clinical Manifestations of Leukocytoclastic Vasculitis, Treatment, and Outcome in Patients with Ulcerative Colitis: A Systematic Review of the Literature

Abstract

Leukocytoclastic vasculitis (LCV) is a rare extraintestinal manifestation (EIM) of ulcerative colitis (UC). Observations about its association with UC stem from case reports and small case series. Due to its rarity, more rigorous cross-sectional studies are scarce and difficult to conduct. The aim of this systematic review was to synthetize the knowledge on this association by reviewing published literature in the form of both case reports and case series; and report the findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In contrast to LCV in Chron disease (CD), which occurs secondary to biologic therapies used for its treatment, LCV in UC is a true reactive skin manifestation. Both genders are equally affected. Palpable purpura (41%) and erythematous plaques (27%) are the most common clinical manifestations. In 41% of patients, the rash is painful, and the lower extremities are most commonly involved (73%). Systemic symptoms such as fever, arthralgias, fatigue, and malaise are seen in 60% of patients. Unlike previous reports, we found that LCV more commonly occurs after the UC diagnosis (59%), and 68% of patients have active intestinal disease at the time of LCV diagnosis. Antineutrophil cytoplasmic antibody (ANCA) is positive in 41% of patients, and 36% of patients have other EIMs present concomitantly with LCV. The majority of patients were treated with corticosteroids (77%), and two (10%) required colectomy to control UC and LCV symptoms. Aside from one patient who died from unrelated causes, all others survived with their rash typically resolving without scarring (82%).

Artificial Intelligence Analysis of Ulcerative Colitis Using an Autoimmune Discovery Transcriptomic Panel

“…Detailed descriptions of the clinicopathological features of ulcerative colitis have been recently published [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. A gene that was highlighted in this research was CD274 ( PD-L1 ).…”

Presence of Phlebitis in Aseptic Nasal Septal Abscess Complicated with Ulcerative Colitis; Possible Association with Granulomatosis with Polyangiitis: A Case Report

“…Recently, aseptic nasal septal abscess has also been reported as a rare manifestation of PG in patients with UC (Yilmaz et al 2011;Chang 2018;Tomioka et al 2018;Yu et al 2020) (Table 1). Additionally, leukocytoclastic vasculitis (a form of small-vessel vasculitis) is one of the extra-intestinal manifestations of UC, and it has been reported that 41% of patients with UC complicated with leukocytoclastic vasculitis are positive for ANCA (Pantic et al 2022). Therefore, patients with PR3-ANCA-positive UC are prone to develop small-vessel vasculitis.…”

Leukocytoclastic Vasculitis of the Foot and Ankle: A Case Report With Over Five-Year Follow-Up

“…Moreover, previous works have found that systemic causes account for the majority of LCV cases [ 2 , 18 ] However, in a relatively large case series of 93 patients, idiopathic cases accounted for 44.1%. And extracutaneous involvement was not discovered in 60.2% of cases [ 18 ]. Extracutaneous involvement, despite extensive workup, was negative in our patient.…”