- IgA vasculitis as a presentation of human immunodeficiency virus infection. [Journal Article]
- RCReumatol Clin 2018 May 15
- IgA vasculitis is a small-vessel vasculitis mediated by immune complexes. In clinical terms, it is characterized by palpable purpura in the lower limbs, joint involvement in the form of arthralgia or...
IgA vasculitis is a small-vessel vasculitis mediated by immune complexes. In clinical terms, it is characterized by palpable purpura in the lower limbs, joint involvement in the form of arthralgia or arthritis, and gastrointestinal and renal involvement (this will mark a poorer prognosis in adults). Infectious processes, mainly in the upper respiratory tract, are frequently found to be triggers. On the other hand, human immunodeficiency virus (HIV) causes immune dysfunction, which triggers hypergammaglobulinemia and can trigger autoimmune disorders. At times, this can affect the vascular endothelium, giving rise to vasculitic manifestations, although there are few reports in the literature of its role in the presentation of HIV.
- Pyoderma gangrenosum-like ulcerations in granulomatosis with polyangiitis: two cases and literature review. [Review]
- RIRheumatol Int 2018 May 02
- Granulomatosis with polyangiitis (GPA) is a systemic necrotizing small vessel vasculitis associated with circulating anti-neutrophil cytoplasmic antibodies (ANCAs). Skin manifestations, mostly repres...
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing small vessel vasculitis associated with circulating anti-neutrophil cytoplasmic antibodies (ANCAs). Skin manifestations, mostly represented by palpable purpura, papulonodular lesions and livedo reticularis, are present in up to 50% of the cases. Ulcerations with undermined, raised erythematous-violaceous border resembling pyoderma gangrenosum (PG) have rarely been reported as skin involvement in GPA. The presence of circulating ANCAs with a cytoplasmic labelling pattern, the involvement of internal organs, particularly of the lung, and the absence on histology of a mainly neutrophilic infiltrate in early phases of the cutaneous lesions may be regarded as clues to rule out true PG and confirm the diagnosis of GPA skin ulcerations simulating PG. Herein, we describe two paradigmatic cases of such a unique presentation of GPA and a literature review focusing on clinicopathological features of GPA presenting with PG-like ulcerations in the skin has been provided. Moreover, referring to the scenario observed in these two cases, an easy-to-use working approach for the differential diagnosis between the two conditions has also been proposed.
- Bullous Henoch-Schönlein purpura. Case report. [Journal Article]
- RCRev Chil Pediatr 2018; 89(1):103-106
- CONCLUSIONS: Although bullous lesions in HSP does not add morbidity, it is often an alarming phenomenon with multiple differential diagnoses. The anti-inflamatory effect of corticoids is likely to be beneficial in the treatment of patients with severe cutaneous involvement through inhibition of proinflammatory transcription factors and decreasing the production of the metalloproteinases.
- Diagnosing IgA Vasculitis in the Active Duty Population: The Importance of Early Diagnosis and Proper Biopsy Site Selection. [Journal Article]
- MMMil Med 2018 Mar 26
- Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdo...
Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdominal pain. It is the most common vasculitis in children, and is less common in adults. However, newer evidence suggests the incidence within the adult population is higher than previously reported. This case study demonstrates an adult military recruit presenting with new onset IgAV shortly after basic training. He noted a preceding upper respiratory tract infection, which is a common finding in those presenting with IgAV. The diagnosis was made by clinical findings, histopathological results and direct immunofluorescence. Adults tend to develop more necrotic and bullous lesions when compared with children. This can skew histopathology and direct immunofluorescence. There is no clear consensus in current literature for whether to obtain lesional or perilesional biopsies. Such recommendations could be particularly advantageous for adults given the abnormal lesions. This case study addresses the incidence of IgAV within the adult population, diagnostic criteria, long-term sequalea of IgAV, and the importance of a proper biopsy sight when making the diagnosis.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Leukocytoclastic vasculitis, also known as “hypersensitivity vasculitis” is a histopathologic diagnosis given to cutaneous, small vessel vasculitis, specifically a vasculitis of the dermal post-capil...
Leukocytoclastic vasculitis, also known as “hypersensitivity vasculitis” is a histopathologic diagnosis given to cutaneous, small vessel vasculitis, specifically a vasculitis of the dermal post-capillary venules. The vasculitis is most often idiopathic. However, there are many other triggers including, but not limited to, infections, neoplasms, inflammatory disorders, and drug-induced vasculitis. Key clinical features of leukocytoclastic vasculitis include palpable purpura, lower extremity location, small vessel involvement, and extracutaneous involvement in approximately 30% of patients. If leukocytoclastic vasculitis is suspected, a punch biopsy should be performed with direct immunofluorescence studies. If no systemic symptoms are present, laboratory testing including ESR, complete blood count (CBC), basic metabolic panel, liver function tests, and urinalysis should be done as well. If there is a concern for systemic involvement, a more extensive workup can be performed. Most cases of cutaneous, small vessel vasculitis are self-limited with 90% resolving in weeks to months of onset. Otherwise, treatment depends on the severity of disease and can range from an oral corticosteroid taper to various steroid-sparing agents.
- A case of leukocytoclastic vasculitis caused by novel anticoagulant rivaroxaban. [Case Reports]
- DODermatol Online J 2017 Nov 15; 23(11)
- Cutaneous leukocytoclastic vasculitis (LCV) is type of small vessel vasculitis that commonly presents as palpable purpura involving the lower extremities and buttocks. Approximately half of cases are...
Cutaneous leukocytoclastic vasculitis (LCV) is type of small vessel vasculitis that commonly presents as palpable purpura involving the lower extremities and buttocks. Approximately half of cases are idiopathic, but the disease may be triggered by infection, drug reaction, inflammatory disease, or other causes. We report a case of leukocytoclastic vasculitis secondary to the novel anticoagulant rivaroxaban (Xarelto®).
- Pazopanib-Induced Cutaneous Leukocytoclastic Vasculitis: An Exclusion Diagnosis of a Multidisciplinary Approach. [Journal Article]
- CRCase Rep Oncol 2017 Sep-Dec; 10(3):1041-1049
- In phase II/III trials, cutaneous side effects of pazopanib were reported in less than 20% of patients, with only 1-3% being grade 3/4. We present a case of a 66-year-old man with a previous history ...
In phase II/III trials, cutaneous side effects of pazopanib were reported in less than 20% of patients, with only 1-3% being grade 3/4. We present a case of a 66-year-old man with a previous history of left nephrectomy for a stage II clear cell renal carcinoma. Approximately 18 months later, recurrent disease in the lungs, mediastinum, and left psoas and bulky abdominal/pelvic nodal metastasis were documented. He was initially treated with pazopanib 800 mg q.d. and 1 week after starting this therapy, the patient presented with palpable purpura on his ankles. These lesions regressed within 2 weeks off pazopanib, but had recurred 4 weeks after he resumed medication at 400 mg q.d. Biopsy of the lesions revealed leukocytoclastic vasculitis. Despite tumour response to therapy, pazopanib was discontinued with total resolution of this skin toxicity within 2 weeks of his cutaneous toxicity. To the best of our knowledge, we report a rare yet significant cutaneous adverse reaction to pazopanib.
- Cutaneous and systemic vasculitides in dermatology: a histological perspective. [Journal Article]
- GIG Ital Dermatol Venereol 2018; 153(2):185-193
- Cutaneous vasculitides encompass a wide and heterogeneous group of diseases affecting skin blood vessels that are clinically characterized by polymorphic skin lesions, particularly including palpable...
Cutaneous vasculitides encompass a wide and heterogeneous group of diseases affecting skin blood vessels that are clinically characterized by polymorphic skin lesions, particularly including palpable purpura as well as urticarial and necrotic-ulcerative lesions, with possible, albeit rare, extracutaneous involvement. Cutaneous leukocytoclastic angiitis and urticarial vasculitis, which are the two prototypic and most common variants of this group, are usually idiopathic but may also be induced by different triggers, notably drugs and infections, or may manifest in association with systemic disorders, particularly lupus erythematosus. Vasculitis skin lesions can also occur during the chronic-relapsing course of systemic vasculitides, such as granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis, with which cutaneous vasculitides can share clinical and histological features. In order to make the diagnosis of a specific form of vasculitis, the cutaneous picture and clinical history of the patient have to be correlated with the histological pattern, direct immunofluorescence findings, laboratory data and possible presence of extracutaneous manifestations. Histology is pivotal for the diagnosis of vasculitis and timing of the biopsy is relevant to correctly evaluate the characteristics of the inflammatory infiltrate. In this review, we will focus in particular on the histological features of cutaneous vasculitides in order to differentiate them from the systemic forms and to avoid misdiagnosis when skin involvement is the presenting sign of a multisystem vasculitis.
- Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia. [Journal Article]
- MJMed J Malaysia 2017; 72(6):345-349
- CONCLUSIONS: The clinical spectrum of cutaneous vasculitis in our population was similar to other studies. Ulcerative lesion predicts a chronic outcome.
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- Palpable Purpura in a Boy With Abdominal Pain: Challenge. [Journal Article]
- AJAm J Dermatopathol 2018; 40(1):e6