Cutaneous leukocytoclastic vasculitis. Clinical and laboratory features of 82 patients seen in private practice

Abstract

Eighty-two patients, with pathologically confirmed cutaneous leukocytoclastic vasculitis (LV), were seen in private dermatology offices. An analysis of the group was made to determine the relationship of cutaneous to systemic disease, the incidence and importance of laboratory abnormalities, and the prognosis of patients with cutaneous LV and to compare these results with previously published data derived from medical centers. Systemic disease occurred in 42 patients, but was transient and mild in most. Two patients died as a result of systemic vasculitis. The morphologic type of skin lesions most commonly found were palpable purpura (51 patients), urticarial-like lesions (17 patients), ulcers (eight patients), erythematous plaques (five patients), and/or nodules (five patients). Possible causative agents could be identified in 38 patients and included drugs (eight patients), infections (eight patients), or collagen vascular disease (17 patients). The course of the disorder was acute in 46 cases, chronic in 24, and recurrent in 12. The patients described herein fared better and had less significant systemic disease than those described in studies from medical centers. The data support the usual benign course of cutaneous LV as seen by practitioners despite frequent systemic symptoms or findings.

Original Artic Le: Leucocytoclastic Vasculitis: A Clinicopathological Study

“…Symptoms such as burning and itching were present in 70%, pain in 35%, this is comparable with the previous study done by gupta et al in which 30% patients had painful lesions. [8] Fever was seen in only 40% of our patients while it was seen in 31.6% patients by Sais et al [7] Arthral gias were seen in 45% of patients in present study, mainly large joints (knee joints>ankles>elbow>wrists), small joint arthritis was seen in one patient [Which is consistent with connective tissue disease Syatemic lupus erythematosus.This is comparable with study done by gupta et al [11] where musculoskeletal system involvement was seen in 36% patients. This was again in consistent with study by Ekenstam et al [9] where musculoskeletal system was commonly involved system in 43% patients and study done by Sais et al [7] with joint involvement in 36.7% of all cases.…”

“…Same patients has history of hematuria consistent with vasculitis of renal glomeruli. The collagen vascular disease workup revealed positive ANA in two patients, whch is consistent with study one by gupta et al (6%) [11] Histopathology all patients had leucocytoclasia, neutrophilic infiltration in the vessel wall, fibrinoid necrosis, extravasation of RBCS and neutrophils. Direct immunoflorescence was positive in 15 cases (75%) with predominant C3, followed by IgG and IgA.…”

“…This was again in consistent with study by Ekenstam et al [9] where musculoskeletal system was commonly involved system in 43% patients and study done by Sais et al [7] with joint involvement in 36.7% of all cases. Gastrointestinal (GIT) involvement was seen in 40% of our patients mainly in the form of pain in abdomen, diarrhea, frank blood and occult blood in stools in LCV, GIT involvement was seen in 26% in gupta et al study, [11] while it was seen in 9.5% cases by Sais et al [7] Winkelmann and Ditto [10] found renal involvement in 61% of their patients, while in our study renal involvement was seen in only 25% of patients, as 5 patients had albuminuria and 2 patients has hematuria.This is comparable with study done by gupta et al [11] where renal involvement was seen in 16%.10 % of patients in present study had urine culture and sensitivity for ecoli which is consistent with the infective etiology of vasculitis.…”

Leukocytoclastic Vasculitis Drug Reaction to Certolizumab Pegol

“…It can also result in permanent scarring (5). Common presentations of LCV include palpable purpura, urticaria, ulcers, or nodules (3,6). Th ese lesions may be exquisitely painful or pruritic, and lower leg edema and myalgias are frequently present (3).…”

“…Th ese lesions may be exquisitely painful or pruritic, and lower leg edema and myalgias are frequently present (3). Histopathologically, LCV is described as fi brinoid necrosis of dermal small vessels, hemorrhage, thrombosis, and perivascular polymorphonuclear leukocytes (3,6). However, the histologic variability of LCV has been reported to morph over the course of 24 to 48 hours from a neutrophilic-predominant…”