We discussed a case of a young man with HCV and IVDU, presenting with cutaneous vasculitis yesterday. Please see pearls on cutaneous small vessel vasculitis with a specific focus on leukocytoclastic vasculitis!
- Cutaneous vasculitis has an exhaustive list of etiologies – think in big categories of primary vasculitis, medication-induced, or infectious causes!
- Major finding of cutaneous vasculitis is palpable purpura – sometimes these lesions can coalesce, ulcerate, or are surrounded by hemorrhagic bullae!
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Disorders that can present with cutaneous small-vessel vasculitis:
- Systemic vasculitis with cutaneous manifestations
o Microscopic polyarteritis
o Granulomatosis with polyangiitis (formerly Wegener’s)
o Eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome)
o IgA vasculitis (Henoch-Schonlein purpura)
o polyarteritis nodosa
2. Paraneoplastic or malignancy-associated vasculitis
3. Medications: penicillins, cephalosporins, sulfa drugs, phenytoin, allopurinol
4. Infection-related Vasculitis: Hepatitis B or C virus, chronic bacteremia (infective endocarditis, infected shunts), HIV
5.Non-inflammatory vascular injury that causes platelet extravasation: scurvy, Ehlers-Danlos syndrome, cholesterol emboli
6. Cryoglobulinemic vasculitis
7. Immune-complex mediated:
o Chronic infections (HBV, Cryoglobulinemic vasculitis (related to HCV) chronic bacteremia, HIV)SLE, Sjogren’s syndrome, Rheumatoid Arthritis, anti-GBM
Framework for thinking about Leukocytoclastic Vasculitis
- See below for the chart that Sarah Goglin (UCSF Rheum attending) uses in her approach to leukocytoclastic vasculitis!