Cutaneous Small Vessel Vasculitis

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!

TOP PEARLS

  • 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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FOR MORE INFORMATION…

Disorders that can present with cutaneous small-vessel vasculitis:

  1. 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!

LCV.png

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