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Skin-nontumor

Other dermatoses

Vasculitis

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 1 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Most cases are due to immune complexes
● May be limited to skin (focal or generalized) or involve internal organs
● Large vessel vasculitis: associated with Churg-Strauss allergic granulomatosis, polyarteritis nodosa, giant cell arteritis, Wegener’s granulomatosis and lymphomatoid granulomatosis
● Leukocytoclastic vasculitis: neutrophilic inflammation with fibrinoid necrosis and fragmented neutrophilic nuclei (leukocytoclasis); it presents as purpuric palpable lesions of lower legs; systemic cases are associated with Henoch-Schonlein pupura (fever, arthralgias, abdominal pain, hematura); also chronic idiopathic urticaria, hypocomplementemia, essential mixed cryoglobulinemia, drug reactions and connective tissue disorders
● Localized vasculitis, non-necrotizing, involving vessels larger than capillaries: granuloma faciale, erythema elevatum diutinum and localized, chronic fibrosing vasculitis
● Lymphocytic, non-necrotizing vasculitis of small, superficial vessels: bilateral nonblanching purpuric and pigmented macules on ankles and lower legs; due to drug eruption, erythema multiforme, Mucha-Habermann disease, some viral infections, collagen vascular disease, PLEVA and erythema multiforme

● Fibrin thrombi: present in segmented, hyalinizing vasculitis
● Infarct of skin: associated with malignant atrophic papulosis (Dego's disease); intimal proliferation of deep-seated arteriole
● Purpura: non-blanching, erythematous macules or papules due to extravasation of red blood cells into dermis
● Septic vasculitis: also referred to (somewhat erroneously) as non-leukocytoclastic vasculitisis, a variant of acute vasculitis associated with various septicemic states, including meningococcal, gonococcal, Pseudomonas and Streptococcal septicemia, infective endocarditis (particularly due to Staphylococcus aureus), secondary syphilis and rickettsial infections

Clinical images
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Various images

Micro description
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● Inflammatory infiltrate in wall of dermal or subcutaneous vessels; may be neutrophilic, lymphocytic or granulomatous
● Often red blood cell extravasation
● Variable fibrinoid necrosis of vessel walls
● Variable secondary changes in overlying epidermis and sweat glands

Micro images
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Small vessel vasculitis (drug induced)

   
Other vasculitis


Lupus related vasculitis

Virtual slides
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Leukocytoclastic vasculitis

Positive stains
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● Immunoglobulins, complement or fibrin in the vessel wall by direct immunofluorescence

Differential diagnosis
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● Sweet’s syndrome: neutrophils in dermis, but no distinct vascular involvement

Additional references
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● eMedicine - leukocytoclastic vasculitis

End of Skin-nontumor> Other dermatoses > Vasculitis

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