Microscopic polyarteritis. Report of a case with cutaneous involvement and antimyeloperoxidase antibodies

Homas, Pamela Bostic; David-Bajar, Kathleen M.; Fitzpatrick, James E.; West, Sterling G.; Tribelhorn, Dwight R.

doi:10.1001/archderm.128.9.1223

Cited by 17 publications

(8 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…169,[201][202][203][204][205][206][207][208][209][210] The most common skin lesions found in MPA are (palpable) purpura and petechiae ($75%); other manifestations found in 20% or less of patients are splinter hemorrhages, nodules, palmar erythema, and livedo. 169,199,[201][202][203][204][205][206][207][208][209][210][211] Urticaria, hemorrhagic bullae, infarcts, facial edema, annular purpura, PG-like ulcers, EED, and telangiectases have been described in rare patients. 199,201,203,204,208,210 Most skin biopsies will demonstrate a small-vessel neutrophilic vasculitis that can affect dermal (upper and middermis mostly) or subcutaneous small vessels (,70%).…”

Section: Churg-strauss Vasculitismentioning

confidence: 99%

“…199,201,203,204,208,210 Most skin biopsies will demonstrate a small-vessel neutrophilic vasculitis that can affect dermal (upper and middermis mostly) or subcutaneous small vessels (,70%). 169,201,[203][204][205][206][207][208][209][210] Biopsies that fail to demonstrate small-vessel vasculitis show either a mixed lymphocytic and neutrophilic or predominately lymphocytic perivascular infiltrate affecting the upper and middermis 203,208 ; these findings may reflect the timing of the biopsy. An arteriolitis of deep dermal and subcutaneous vessels is found in a minority of biopsies and can be associated with panniculitis.…”

Section: Churg-strauss Vasculitismentioning

confidence: 99%

See 1 more Smart Citation

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Carlson

Kr²

2006

The American Journal of Dermatopathology

182

151

View full text Add to dashboard Cite

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.

show abstract

Section: Churg-strauss Vasculitismentioning

confidence: 99%

Section: Churg-strauss Vasculitismentioning

confidence: 99%

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Carlson

Kr²

2006

The American Journal of Dermatopathology

182

151

View full text Add to dashboard Cite

show abstract

“…Other findings on the histologic continuum of MPA include lymphocytic perivascular infiltration in the upper dermis, mixed lymphocytic and neutrophilic perivascular infiltration in the mid to deep dermis, and mixed lymphocytic and histiocytic perivascular infiltration in the mid dermis (Seishima et al, 2004). Other non-specific findings of leukocytoclastic vasculitis similar to those seen in cutaneous leukocytoclastic angiitis (CLA) include fibrinoid necrosis and leukocytoclasis (Homas et al, 1992). The clinical appearance of livedo racemosa presents histologically as a vasculitis affecting deep dermal and subcutaneous vessels and a deep incisional biopsy is indicated in these patients to ensure that the subcutis is sampled (Nagai et al, 2009).…”

Section: Microscopic Polyangiitis (Microscopic Polyarteritis)mentioning

confidence: 99%

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

Jordan¹,

Mercer²,

Phelps³

2011

Advances in the Etiology, Pathogenesis and Pathology of Vasculitis

View full text Add to dashboard Cite

“…Les nodules sous-cutanés sont moins fréquents. La biopsie cutanée peut révéler une vascularite des vaisseaux de petit calibre, parfois nécrosante, mais montre souvent uniquement des aspects de vascularite leucocytoclasique [33], peu spécifiques. En général, l'ensemble de ces manifestations cutanées disparaît rapidement sous traitement.…”

Section: Manifestations Cutanéesunclassified

Polyangéite microscopique

2007

View full text Add to dashboard Cite

Microscopic polyangiitis was initially considered a "microscopic" form of polyarteritis nodosa and was not definitively distinguished from it until the Chapel Hill nomenclature (1994). Microscopic polyangiitis is a systemic necrotizing vasculitis of small vessels. Its typical clinical manifestations are rapidly progressive glomerulonephritis and alveolar hemorrhage. Other possible symptoms resemble those encountered in polyarteritis nodosa. Microscopic polyangiitis belongs to the group of ANCA-associated vasculitides, and 75-80% of patients have pANCA to myeloperoxidase (MPO). Anti-MPO ANCA pathogenicity has been established in animal models, and a recent report describes transplacental transfer of these antibodies in humans, resulting in pulmonary hemorrhage and renal involvement in the newborn. Patients with no poor prognostic factors, as defined by a five-factor score, can be treated with corticosteroids alone, with immunosuppressants added only in case of treatment failure. Patients with one or more poor prognostic factors must receive a combination of corticosteroids and immunosuppressants, mainly intravenous pulsed cyclophosphamide, with plasma exchange as an adjuvant therapy for those with severe renal involvement. Once remission is achieved, maintenance therapy can replace cyclophosphamide by azathioprine or methotrexate. Biological therapies are under evaluation. The remission rate is above 80% with these regimens, and the relapse rate is around 30% at 5 years, lower than for Wegener's granulomatosis.

show abstract

Microscopic polyarteritis. Report of a case with cutaneous involvement and antimyeloperoxidase antibodies

Cited by 17 publications

References 24 publications

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

Polyangéite microscopique

Contact Info

Product

Resources

About