Cutaneous vasculitides: Clinico-pathological correlation

Gupta, Subash; Handa, Sanjeev; Kanwar, Amrinder J.; Radotra, Bishan Dass; Minz, Ranjana Walker

doi:10.4103/0378-6323.53130

Cited by 17 publications

(5 citation statements)

References 8 publications

(10 reference statements)

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“…Eight per cent of our patients had gastrointestinal involvement as reported by others79. In a recent series from India, 22 per cent of the patients had GI involvement5. Consistent with the earlier studies, elevated ESR was the most common laboratory abnormality seen in nearly two-thirds of our patients49–11.…”

Section: Discussionsupporting

confidence: 90%

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An aetiological & clinicopathological study on cutaneous vasculitis

et al. 2012

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Background & objectives:Cutaneous vasculitis has protean clinical manifestations. It may be idiopathic or associated with a spectrum of conditions such as infections, drugs, etc. Skin is involved in both small vessel vasculitis (SVV) and medium vessel vasculitis (MVV). Overlapping features are seen between SVV and MVV. The histopathological features may not always relate with the clinical lesions. The aim of the present study was to evaluate the aetiological factors and clinicopathological association in patients with cutaneous vasculitis.Methods:In this cross-sectional study, detailed history and clinical examination were done on patients with biopsy proven cutaneous vasculitis. Two skin biopsies were taken from each patient for routine histopathology and direct immunofluorescence.Results:Of the 61 patients studied, hypersensitivity vasculitis (HSV) [23 (37.7%)] and Henoch Schonlein purpura (HSP) [16 (26.2%)] were the two most common forms. Systemic involvement was seen in 32 (52.45%) patients. Drugs were implicated in 12 (19.7%) cases, infections in 7 (11.4%) and connective tissue disorders in 4 (6.5%) cases. Histologically SVV was the most common pattern, seen in all the clinically diagnosed patients with SVV (47), and in 12 of the 14 clinically diagnosed patients with MVV. Direct immunofluorescence showed positivity for at least one immunoreactant in 62 per cent of the patients and the most common deposit was C3 followed by IgG, IgA and IgM.Interpretation & conclusions:Majority of our patients with cutaneous vasculitis were idiopathic. Histologically, SVV was seen in most of our patients. No association was seen between history of drug intake and tissue eosinophilia and also between histologically severe vasculitis and clinical severity. The presence of immunoreactant IgA was not specific for HSP.

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Section: Discussionsupporting

confidence: 90%

“…There are only few studies from India on cutaneous vasculitis45. Hence we undertook this study to evaluate the aetiological factors and clinicopathological association with clinical lesions in patients with cutaneous vasculitis in a tertiary care hospital in north India.…”

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confidence: 99%

An aetiological & clinicopathological study on cutaneous vasculitis

et al. 2012

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“…[7] However, very few studies have actually tried to compare the general positivity in the routine biopsies of skin for vasculitis, a few of which are depicted in Table 3. [18–10]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Cutaneous vasculitis (CV) comprises a wide spectrum of diseases that involve predominantly the blood vessels and surrounding tissues of the skin. The vasculitis may be idiopathic or with an identifiable cause such as drugs, infection or connective tissue disease.…”

Section: Introductionmentioning

confidence: 99%

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Nandeesh

Tirumalae²

2013

Indian J Dermatol

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Background:Cutaneous vasculitis is commonly recognized and biopsied, owing to ease of access. Most biopsies are also subjected to direct immunofluorescence (DIF), though the rates of positivity vary. This is an attempt to assess the utility of DIF and glean data that will help optimize the test.Objective:To assess the diagnostic utility of DIF in cutaneous vasculitis.Materials and Methods:All cases of suspected cutaneous vasculitis submitted for DIF between 2004 and 2010 were included. Clinical data, histopathologic diagnosis, DIF findings and additional tests such as anti nuclear antibody (ANA), anti neutrophil cytoplasmic antibody (ANCA) (where done) were noted.Results:There were 198 patients in the study group, with a female predominance. Purpura was the commonest clinical presentation. Extracutaneous involvement was noted in 29% of patients’ i.e., joint pain, abdominal pain and hematuria. Leukocytoclastic vasculitis was the commonest histologic diagnosis. DIF showed an overall positivity of 39% (n = 77) with C3 in 26% (n = 52) and IgA in 23% (n = 46) cases. Forty one cases of suspected Henoch Schonlein Purpura (HSP) showed IgA positivity. The timing of biopsy ranged from <3 days to six months, with 38% being done within seven days. DIF was positive in 86% of biopsies performed within seven days of onset of lesions. Sixty percent of patients with extracutaneous manifestations showed deposits. Vascular deposits were also noted in dermatitis herpetiformis, dematomyositis and prurigo.Conclusion:DIF positivity is strongly influenced by the timing of the biopsy and the presence of extracutaneous features. Its clinical value is greatest in patients with HSP, being contributory in 90% of cases. Vascular deposits may be seen in non-vasculitic conditions and need clinicopathologic correlation.

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“… 17 , 18 LCV is a clinico-histopathological diagnosis that is confirmed by biopsy showing immune complex deposition in small-vessel walls, most commonly dermal postcapillary venules. 17 , 19 , 20 , 21 The precise pathophysiology of LCV remains poorly understood. However, the influence of circulating immune complexes (detected with direct immunofluorescence [DIF]) and neutrophil recruitment (detected with the histological specimen) on the integrity of the blood vessel wall is believed to play a major role.…”

Section: Introductionmentioning

confidence: 99%

Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis

Akhavanrezayat

Hien

Pham

et al. 2020

American Journal of Ophthalmology Case Reports

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Purpose To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved. Conclusion and importance Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan.

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Cutaneous vasculitides: Clinico-pathological correlation

Cited by 17 publications

References 8 publications

An aetiological & clinicopathological study on cutaneous vasculitis

An aetiological & clinicopathological study on cutaneous vasculitis

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis

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