Dermatohistopathology of chronic gonococcal sepsis

SummaryAimsThe classifications of occluding vasculopathies may present some difficulties. Firstly, classifications may follow different principles, e.g. clinicopathological findings, etiology or pathomechanism. Secondly, authors sometimes do not distinguish between vasculitis and vasculopathy. Thirdly, vasculopathies are often systemic diseases. Organ‐specific variations make morphologic findings difficult to compare. Moreover, subtle changes may be recognized in the skin, but be invisible in other organs. Our aim was to use the skin and subcutis as tools and clinicopathological correlation as the basic process for classification.Methods and resultsIn the first step, we differentiate between small and medium vessel occluding vasculopathies in the skin, and focus in this part on small vessel occluding vasculopathies. In the second step, we differentiate among subtypes of small vessels. In the final step, we differentiate according to the time point of the coagulation/reorganization process and the involved inflammatory cells/stromal features. Applying the same procedure to the various entities and visualizing the findings with bar codes makes the similarities and differences more apparent, both clinically and with histopathology.ConclusionOccluding vasculopathies are often not separate entities, but reaction patterns and epiphenomena. Distinguishing them from vasculitides is crucial because of differences in pathogenesis, therapeutic approach and prognosis.

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“…Septic vasculitis (Table 5) presents another paradox [3,36,37]. The pathomechanism starts at the vessel wall as classic vasculitis.…”

Section: Septic Vasculitismentioning

confidence: 99%

Bar code reader – an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies

Ratzinger

Zelger

2019

J Deutsche Derma Gesell

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“…[79][80][81] Clinically, the extremities and sites of pressure develop hemorrhagic lesions (petechiae mostly), pustular purpura, and vesiculopustular lesions (vesicles, bullae, and erythematous macules and nodules surmounted by small pustules). [80][81][82][83][84][85][86] Histologically, septic vasculitis differs from conventional small-vessel neutrophilic vasculitis by the finding of occlusive luminal thrombi composed of platelets, red blood cells, fibrin, and neutrophils. Relative to CLA, there is less nuclear debris (leukocytoclasia), deep dermal and arteriolar involvement, marked hemorrhage, and the common presence of subepidermal and intraepidermal pustules with epidermal necrosis.…”

Section: Infection-induced Vasculitismentioning

confidence: 99%

“…5). 82,85,88 DIF examination has shown vascular deposits of immunoglobulin and complement in the majority of skin biopsies of acute meningococcemia. 88…”

Section: Infection-induced Vasculitismentioning

confidence: 99%

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Carlson

Kr²

2006

The American Journal of Dermatopathology

180

151

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A broad and diverse spectrum of vasculitic syndromes exists. These syndromes affect the skin with varying levels of associated systemic manifestations, running the gamut from a self-limited, localized, cutaneous phenomenon to rapidly progressive, multiorgan disease. The majority of cases of cutaneous vasculitis will show a neutrophilic small vessel vasculitis that can be either a primary (idiopathic) disorder (eg, cutaneous leukocytoclastic angiitis) or a secondary disorder that is associated with drugs, infection (eg, streptococcal infection, viral hepatitis), or underlying disease (eg, connective tissue disease, malignancy). Biopsy is the gold standard for the diagnosis of cutaneous vasculitis and also necessary for the detection of cutaneous vascular immune complexes by direct immunofluorescence. Based on the type of vessel disrupted by inflammation (small and/or muscular), the distribution of vasculitis in the dermis and subcutis, and predominate inflammatory cell-type mediating vessel wall damage, a list of relevant differential diagnoses can be generated. This histologic information coupled with extravascular findings such as tissue eosinophilia, tissue neutrophilia, and/or granulomas, plus pathophysiologic markers such as direct immunofluorescent examination for immune complexes and serologic evaluation for antineutrophil cytoplasmic antibodies allows for more accurate diagnosis of specific vasculitic entities. Herein, we review both primary and secondary vasculitic syndromes that affect the skin and show a small vessel neutrophilic mediated vasculitis.

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“…As compared to conventional small vessel neutrophilic vasculitis, septic vasculitis has scant perivascular fibrin and fibrin thrombi and little to no nuclear debris (Carlson, 2010). Arteriolar involvement, hemorrhage, and subepidermal and intraepidermal pustules help distinguish septic vasculitis from cutaneous leukocytoclastic angiitis (Shapiro et al, 1973). Epidermal changes include edema, intra-epidermal or subcorneal pustules, and epidermal necrosis (Shapiro et al, 1973).…”

Section: Septic Vasculitismentioning

confidence: 99%

“…Arteriolar involvement, hemorrhage, and subepidermal and intraepidermal pustules help distinguish septic vasculitis from cutaneous leukocytoclastic angiitis (Shapiro et al, 1973). Epidermal changes include edema, intra-epidermal or subcorneal pustules, and epidermal necrosis (Shapiro et al, 1973). Gram stain is typically negative in septic vasculitis, however, gram negative rods can be seen within the cytoplasm of neutrophils, within endothelial cells, and admixed with extravasated red blood cells in acute meningococcemia (Sotto et al, 1976).…”

Section: Septic Vasculitismentioning

confidence: 99%