1
|
Estrella J, George S, Hariri D, Zaccarini DJ, Sura A. Cutaneous Vasculitis as the Initial Presentation of Juvenile Myelomonocytic Leukemia. Clin Pediatr (Phila) 2024; 63:1013-1016. [PMID: 37776241 DOI: 10.1177/00099228231202908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
MESH Headings
- Humans
- Leukemia, Myelomonocytic, Juvenile/diagnosis
- Leukemia, Myelomonocytic, Juvenile/complications
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Male
- Female
- Diagnosis, Differential
Collapse
Affiliation(s)
- Jewel Estrella
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Simi George
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Dana Hariri
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Daniel J Zaccarini
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anjali Sura
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
2
|
Xing Y, Zhuang C, Yu Q, Liu C, Xu M, Zhao L, Kong X. Cutaneous leukocytoklastic vasculitis in a patient with ankylosing spondylitis: A case report. Heliyon 2024; 10:e28134. [PMID: 38524579 PMCID: PMC10958421 DOI: 10.1016/j.heliyon.2024.e28134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Extra-articular manifestations (EAMs) in ankylosing spondylitis (AS) are common and most extra-articular manifestations such as acute iritis and inflammatory bowel disease are positively correlated with disease activity of AS. Vasculitis is an extra-articular manifestation of AS. However cutaneous leukocytoclastic vasculitis (CLV) is uncommon in AS patients. In this article, we report a case of a 66-year-old female patient who has had AS for long time. Although the patient's articular manifestations were stable, the aortic aneurysm and CLV continued to occur sequentially. This article reminds clinicians that even AS patients with stable articular manifestations should be followed up regularly. All extra-articular manifestations of AS patients should be taken seriously and treated as soon as possible under the guidance of rheumatoid immunologists.
Collapse
Affiliation(s)
- Yida Xing
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Chengjun Zhuang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Dalian Medical University, China
| | - Qian Yu
- Wound Stoma Clinic, The Second Affiliated Hospital of Dalian Medical University, China
| | - Changyan Liu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Mingxi Xu
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Lin Zhao
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| | - Xiaodan Kong
- Department of Rheumatology, The Second Affiliated Hospital of Dalian Medical University, China
| |
Collapse
|
3
|
Ramteke V, Pattewar S, Barde N, Deshpande N. Sirolimus-induced leukocytoclastic vasculitis. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:310-312. [PMID: 37994081 PMCID: PMC10772267 DOI: 10.4285/kjt.23.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Affiliation(s)
- Vishal Ramteke
- Department of Nephrology and Transplantation, Alexis Hospital, Nagpur, India
| | - Sainath Pattewar
- Department of Nephrology and Transplantation, Shri Balaji Institute of Medical Sciences, Raipur, India
| | - Nitin Barde
- Radiance Skin Anti-aging and Hair Transplant Clinic, Nagpur, India
| | - Nishant Deshpande
- Department of Nephrology and Transplantation, Alexis Hospital, Nagpur, India
| |
Collapse
|
4
|
Yokoyama K, Kino T, Nagata T, Miyayama T, Shibata K, Fukuda H, Yamauchi R, Fukunaga A, Umeda K, Takata K, Tanaka T, Shakado S, Sakisaka S, Imafuku S, Hirai F. Hepatitis C Virus-associated Cryoglobulinemic Livedo Reticularis Improved with Direct-acting Antivirals. Intern Med 2023; 62:3631-3636. [PMID: 37121750 PMCID: PMC10781547 DOI: 10.2169/internalmedicine.1671-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
We herein report a case of hepatitis C virus (HCV)-associated cryoglobulinemic livedo reticularis in a woman in her 60s that improved with direct-acting antivirals (DAAs). Hyperpigmentation was observed in both lower legs, and a skin biopsy confirmed livedo reticularis, suggesting a relationship with cryoglobulinemia and HCV infection. DAAs with an NS5A inhibitor+NS3/4A protease inhibitor (glecaprevir/pibrentasvir) were administered for eight weeks, and a sustained virological response (SVR) was obtained. The disappearance of serum cryoglobulin was confirmed approximately two years after an SVR was obtained and livedo reticularis was improved. DAA therapy can be an effective therapeutic option for extrahepatic complications associated with HCV infection.
Collapse
Affiliation(s)
- Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Tomohiro Kino
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Takahiro Nagata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Takashi Miyayama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Kumiko Shibata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Atsushi Fukunaga
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Kaoru Umeda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Japan
| |
Collapse
|
5
|
Wang HY, Robson DC, Kim SJ. Annular vasculitic lesions. Clin Dermatol 2023; 41:326-339. [PMID: 37423264 DOI: 10.1016/j.clindermatol.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Vasculitic skin findings may present with annular morphologies. This group of conditions consists of capillaritis, such as pigmented purpuric dermatoses, and vasculitis, which is often classified by the affected vessel size. Annular vasculitic lesions may be the presenting sign of systemic disease, thus requiring thorough exploration to reach an accurate diagnosis and guide proper disease management. Herein we review the clinical presentation, histopathology, and treatments for cutaneous vasculitic disease that may present with annular lesions.
Collapse
Affiliation(s)
| | | | - Soo Jung Kim
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
6
|
Guevara-Rodriguez N, Flores-Chang M, Chilakala A, Contreras J, Perdomo P, Liliya G. A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA-negative (Anti-Neutrophil cytoplasmic antibody) case report and literature review. Clin Case Rep 2023; 11:e7030. [PMID: 36873078 PMCID: PMC9981573 DOI: 10.1002/ccr3.7030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Leukocytoclastic vasculitis is an entity associated with drugs, infections, cryoglobulinemia, and connective tissue diseases but can also be idiopathic, systemic, or organ localized. Moreover, LCV associated with drugs is a rare disorder. When it is present usually has an elevation of anti-neutrophil cytoplasmic antibody, most likely anti-myeloperoxidase, which can be helpful to orient the diagnosis. We are presenting a 55-year-old female with a past medical history of diabetes mellitus (DM) and hyperlipidemia (HLD) who presented with a painful and pruritic rash localized in the abdomen and lower extremities that started 1 week after initiated atorvastatin for management of hyperlipidemia. This is the first case ever reported of leukocytoclastic vasculitis ANCA negative associated with atorvastatin, to our best knowledge.
Collapse
Affiliation(s)
| | - Mailing Flores-Chang
- Department of Medicine, Internal Medicine St. Barnabas Hospital Health System Bronx New York USA
| | - Akhila Chilakala
- CUNY School of Medicine, Medical school in New York City New York New York USA
| | - Jose Contreras
- Department of Medicine, Internal Medicine St. Barnabas Hospital Health System Bronx New York USA
| | - Paula Perdomo
- Department of Medicine, Internal Medicine St. Barnabas Hospital Health System Bronx New York USA
| | - Gandrabur Liliya
- Internal Medicine, Department of Rheumatology St. Barnabas Hospital Health System Bronx New York USA
| |
Collapse
|
7
|
DeHoratius DM. Cutaneous small vessel vasculitis. Postgrad Med 2022; 135:44-51. [PMID: 36524408 DOI: 10.1080/00325481.2022.2159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This review discusses the clinical manifestations of cutaneous small vessel vasculitis. The etiologies and work up will be explored as well as the treatment considerations. This entity is multifactorial and usually involves multiple specialties. The presentation can range from self-limited to life threatening, multi-organ failure. It is essential to be able to diagnose vasculitis and proceed with the appropriate laboratory studies and work-up. Finally, investigation of associated etiologies such as infection and drugs will guide additional diagnostic studies.
Collapse
Affiliation(s)
- Danielle M. DeHoratius
- Bryn Mawr Hospital – Dermatology, 825 Old Lancaster Road Suite 450 Bryn Mawr Pennsylvania, Pennsylvania, United States
| |
Collapse
|
8
|
Sequential Increase in Complement Factor I, iC3b, and Cells Expressing CD11b or CD14 in Cutaneous Vasculitis. Anal Cell Pathol 2022; 2022:3888734. [PMID: 35747245 PMCID: PMC9213176 DOI: 10.1155/2022/3888734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/28/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Mast cells contribute to the pathogenesis of cutaneous vasculitis through complement C3 that is cleaved to C3b and then to iC3b by complement factor I. The receptor of iC3b, CD11b, is expressed on neutrophils and monocytes and CD14 on monocytes. Their role in vasculitis is obscure. In this study, frozen skin biopsies from the nonlesional skin, initial petechial lesion, and palpable purpura lesion from 10 patients with immunocomplex-mediated small vessel vasculitis were studied immunohistochemically for complement factor I, iC3b, CD11b, and CD14. Peripheral blood mononuclear cells from 5 healthy subjects were used to study cell migration and cytokine secretion. Already, the nonlesional skin revealed marked immunostaining of complement factor I, iC3b, CD11b, and CD14, and their expression increased sequentially in initial petechial and palpable purpura lesions. Mast cell C3c correlated to iC3b, and both of them correlated to CD11b+ and CD14+ cells, in the nonlesional skin. The stimulation of mononuclear cells with 0.01-0.1 μg/ml iC3b induced cell migration in the transwell assay. C3a stimulated slightly interleukin-8 secretion, whereas 1 μg/ml iC3b inhibited it slightly, in 4/5 subjects. In conclusion, the C3-C3b-iC3b axis is activated already in the early vasculitis lesion leading to progressive accumulation of CD11b+ and CD14+ cells.
Collapse
|
9
|
Shajil C, Sathishkumar D, George K, Thomas M. Spontaneous splenic rupture: A rare complication in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Indian J Dermatol Venereol Leprol 2022; 88:392-395. [PMID: 35389026 DOI: 10.25259/ijdvl_584_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Chandana Shajil
- Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Dharshini Sathishkumar
- Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Krupa George
- Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
10
|
Miyabe C, Miyabe Y, Miyata R, Ishiguro N. Pathogens in Vasculitis: Is It Really Idiopathic? JMA J 2021; 4:216-224. [PMID: 34414315 PMCID: PMC8355637 DOI: 10.31662/jmaj.2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 11/27/2022] Open
Abstract
Vasculitis is an autoimmune disease characterized by the infiltration of leukocytes in blood vessels. An increasing number of studies on human and animal models have implicated various microorganisms in the pathogenesis of vasculitis. Previous studies have shown the presence of infectious agents, including viruses, bacteria, and fungi, in diseased vessels. However, despite continued research, the link between infection and vasculitis is not fully understood, possibly owing to the lack of appropriate animal models that mirror human disease and the technical limitations of pathogen detection in blood vessels. Among the pathogen-induced animal models, Candida albicans water-soluble fraction (CAWS)-induced coronary arteritis is currently considered one of the representative models of Kawasaki (KD) disease. Advances in metagenomic next-generation sequencing have enabled the detection of all nucleic acids in tissue, which can help identify candidate pathogens, including previously unidentified viruses. In this review, we discuss the findings from reports on pathogen-associated vasculitis in animal models and humans, with a specific focus on the investigation of the pathogenesis of vasculitis. Further studies on animal models and microbes in diseased vessels may provide important insights into the pathogenesis of vasculitis, which is often considered an idiopathic disease.
Collapse
Affiliation(s)
- Chie Miyabe
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshishige Miyabe
- Department of Cell Biology, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
| | - Ryujin Miyata
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoko Ishiguro
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
11
|
Kus KJB, LaChance AH, Vleugels RA. Recognition and Management of Cutaneous Connective Tissue Diseases. Med Clin North Am 2021; 105:757-782. [PMID: 34059249 DOI: 10.1016/j.mcna.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.
Collapse
MESH Headings
- Adult
- Comorbidity
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/drug therapy
- Connective Tissue Diseases/pathology
- Dermatomyositis/diagnosis
- Dermatomyositis/etiology
- Dermatomyositis/pathology
- Diagnosis, Differential
- Drug Therapy/methods
- Drug Therapy/statistics & numerical data
- Drug-Related Side Effects and Adverse Reactions
- Early Diagnosis
- Female
- Humans
- Interdisciplinary Communication
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/etiology
- Lupus Erythematosus, Systemic/pathology
- Male
- Patient Care Management/methods
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis/pathology
Collapse
Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309-4482, USA
| | - Avery H LaChance
- Connective Tissue Disease Clinic, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
| | - Ruth Ann Vleugels
- Autoimmune Skin Disease Program, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
12
|
Zhu KJ, Yang PD, Xu Q. Tofacitinib Treatment of Refractory Cutaneous Leukocytoclastic Vasculitis: A Case Report. Front Immunol 2021; 12:695768. [PMID: 34248994 PMCID: PMC8264360 DOI: 10.3389/fimmu.2021.695768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/11/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction To date, there is no treatment with proven efficacy for cutaneous leukocytoclastic vasculitis (CLV). Several reports have suggested that CLV responds favorably to corticosteroids, colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), azathioprine, and hydroxychloroquine (HCQ). To the best of our knowledge, the oral small molecule Janus kinase inhibitor, tofacitinib, plays an important role in the treatment of autoimmune and inflammatory diseases. Therefore, tofacitinib may be a prospective therapy in patients with CLV. Case Presentation A 29-year-old woman presented to our hospital with a 5-year history of symmetric skin lesions mainly affecting both lower extremities. The results for anti-neutrophil cytoplasmic antibodies (ANCA), anti-extracted nuclear antigens (ENA) autoantibodies, anti-double-stranded deoxyribonucleic acid (dsDNA) antibodies, and antinuclear antibodies (ANA) were all negative. The definite diagnosis of CLV was determined by a skin biopsy. However, the patient exhibited a poor response to prednisone, HCQ, methotrexate, colchicine, azathioprine, and tripterygium wilfordii polyglycoside tablets (TGTs) treatments. She was then treated with oral tofacitinib (5 mg twice daily) and oral prednisone (25 mg daily). Outcomes Her skin lesions gradually improved over a period of 4 weeks. Two months later, the skin ulcers completely resolved. No evidence of recurrence of skin ulcers was observed during a 6-month follow-up. Conclusion We present the first case of a female patient receiving short-term tofacitinib therapy for refractory CLV. Tofacitinib may be a promising oral alternative for patients with CLV. However, its efficacy and safety require further appraisal through clinical trials.
Collapse
Affiliation(s)
- Kai-Jun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rheumatology, Zhengzhou Second Hospital, Guangzhou, China
| | - Pei-Dan Yang
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The First Clinical Medicine School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Xu
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The First Clinical Medicine School, Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
13
|
The Many Faces of Purpura: Vancomycin-Induced Leukocytoclastic Vasculitis. Case Rep Infect Dis 2021; 2021:9932425. [PMID: 34194855 PMCID: PMC8203330 DOI: 10.1155/2021/9932425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/21/2021] [Indexed: 01/17/2023] Open
Abstract
Leukocytoclastic vasculitis is a rare form of immune-mediated vasculitis that might be caused by infections or autoimmune diseases or might be precipitated by specific medications. We describe a 65-year-old patient, who was receiving vancomycin for a methicillin-sensitive Staphylococcus aureus permacath infection. Vancomycin was chosen due to medication non-adherence and the patient's desire to receive antimicrobial therapy in conjunction with his scheduled dialysis sessions. The patient's medical history was notable for untreated hepatitis C infection and end-stage renal disease, requiring hemodialysis three times a week. Vancomycin was administered during dialysis sessions. After one week of therapy, the patient developed bilateral lower extremity purpura. Skin biopsy was suggestive of leukocytoclastic vasculitis with an absence of intravascular thrombi. Serum cryoglobulins were negative, making cryoglobulinemia due to HCV infection unlikely. Following cessation of vancomycin therapy, the rash gradually disappeared with scarring in the form of post-purpuric hyperpigmentation. Despite its widespread use, vancomycin is a rare cause of leukocytoclastic vasculitis. Clinicians should keep in mind a wide range of differential diagnosis of bilateral lower extremity purpura as treatment differs depending on its underlying etiology.
Collapse
|
14
|
Wen Y, Nong L, Wang Y. Painful Cutaneous Plaques on the Lower Legs in a Middle-aged Woman. JAMA Oncol 2021; 6:772-773. [PMID: 32163108 DOI: 10.1001/jamaoncol.2019.6839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yujie Wen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| |
Collapse
|
15
|
Atypical Bacterial Pathogens and Small-Vessel Leukocytoclastic Vasculitis of the Skin in Children: Systematic Literature Review. Pathogens 2021; 10:pathogens10010031. [PMID: 33401725 PMCID: PMC7823485 DOI: 10.3390/pathogens10010031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022] Open
Abstract
Leukocytoclastic small-vessel vasculitis of the skin (with or without systemic involvement) is often preceded by infections such as common cold, tonsillopharyngitis, or otitis media. Our purpose was to document pediatric (≤18 years) cases preceded by a symptomatic disease caused by an atypical bacterial pathogen. We performed a literature search following the Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines. We retained 19 reports including 22 cases (13 females and 9 males, 1.0 to 17, median 6.3 years of age) associated with a Mycoplasma pneumoniae infection. We did not find any case linked to Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, or Legionella pneumophila. Patients with a systemic vasculitis (N = 14) and with a skin-limited (N = 8) vasculitis did not significantly differ with respect to gender and age. The time to recovery was ≤12 weeks in all patients with this information. In conclusion, a cutaneous small-vessel vasculitis with or without systemic involvement may occur in childhood after an infection caused by the atypical bacterial pathogen Mycoplasma pneumoniae. The clinical picture and the course of cases preceded by recognized triggers and by this atypical pathogen are indistinguishable.
Collapse
|
16
|
Yasuda MR, Roller LA, Fagenholz PJ, Hoang MP. Case 33-2020: A 55-Year-Old Man with Abdominal Pain, Joint Swelling, and Skin Lesions. N Engl J Med 2020; 383:1664-1671. [PMID: 33085865 DOI: 10.1056/nejmcpc1916257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mariko R Yasuda
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Lauren A Roller
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Peter J Fagenholz
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Mai P Hoang
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| |
Collapse
|
17
|
Akhavanrezayat A, Hien DL, Pham BH, Nguyen HV, Tuong Ngoc TT, Al-Moujahed A, Uludag G, Karkhur S, Doan HL, Nguyen QD. Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis. Am J Ophthalmol Case Rep 2020; 20:100934. [PMID: 33015410 PMCID: PMC7522751 DOI: 10.1016/j.ajoc.2020.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone. Observations A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved. Conclusion and importance Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan.
Collapse
Affiliation(s)
| | - Doan Luong Hien
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | - Brandon H Pham
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Huy Vu Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Than Trong Tuong Ngoc
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | | | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Huy Luong Doan
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | |
Collapse
|
18
|
Guzman AK, Balagula Y. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment. Clin Dermatol 2020; 38:613-628. [PMID: 33341196 DOI: 10.1016/j.clindermatol.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed.
Collapse
Affiliation(s)
- Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
19
|
Basu P, Russell-Goldman E, Nazarian RM, Das S. Alcohol-Associated Immunoglobulin A Vasculitis: A Case Report and Review of the Literature. Dermatopathology (Basel) 2020; 6:288-293. [PMID: 32596212 PMCID: PMC7315200 DOI: 10.1159/000507307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Immunoglobulin A (IgA)-mediated leukocytoclastic vasculitis is a cutaneous small-vessel vasculitis characterized by skin findings of palpable purpura. It may occur secondary to infections, neoplasms, drugs, and systemic conditions, although it is most commonly idiopathic. A known, but rare, trigger for IgA vasculitis is alcohol consumption. We present a case of a man with IgA vasculitis associated with alcohol use and review the literature on alcohol-associated vasculitis. Although rarely reported, alcohol-associated IgA vasculitis is an important entity to consider for appropriate diagnosis and management of such patients.
Collapse
Affiliation(s)
- Pallavi Basu
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | | | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Gehlhausen JR, Wetter DA, Nelson C, Ramachandran S, McNiff JM, Ko CJ. A detailed analysis of the distribution, morphology, and histopathology of complex purpura in hospitalized patients: A case series of 68 patients. J Am Acad Dermatol 2020; 84:1188-1196. [PMID: 32376433 DOI: 10.1016/j.jaad.2020.04.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Purpura in inpatients commonly leads to dermatologic consultation. The differential diagnosis is broad and algorithms are intricate. OBJECTIVE We evaluated inpatient consultations for complex purpura to document the most common diagnoses and to validate the true diagnostic utility of histopathology, clinical morphology, and distribution. METHODS We reviewed a case series of 68 inpatients during a 4-year period with a dermatologic consultation for purpura and biopsy findings of vasculitis or microvascular occlusion. RESULTS Key features of complex purpura are nonbranching (round) versus branching (retiform) morphology, dependent versus acral or generalized distribution, and leukocytoclastic vasculitis versus microvascular occlusion (with emphasis on depth of involvement). Dependent nonbranching purpura with only superficial vessels involved by leukocytoclastic vasculitis was most often due to IgA vasculitis or cutaneous single-organ small-vessel vasculitis. In contrast, deeper involvement by leukocytoclastic vasculitis was suggestive of systemic disease (eg, antineutrophil cytoplasmic antibody-associated vasculitis). Branching purpura was concerning, with greater than 90% sensitivity and specificity for microvascular occlusion and associated high mortality (≈50%). The majority of patients who died had acral branching lesions. LIMITATIONS Small sample size, inpatients at a tertiary care center, and retrospective nature are some limitations. CONCLUSION Nonbranching dependent purpura corresponded to leukocytoclastic vasculitis, with the most common diagnoses being IgA vasculitis or skin-limited small-vessel vasculitis; patients with deep involvement often had systemic diseases. In this series, branching purpura was due to microvascular occlusion rather than medium-vessel vasculitis, and had associated high mortality.
Collapse
Affiliation(s)
- Jeff R Gehlhausen
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | - David A Wetter
- Mayo Clinic Department of Dermatology, Rochester, Minnesota
| | - Caroline Nelson
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut
| | | | - Jennifer M McNiff
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut
| | - Christine J Ko
- Yale School of Medicine Department of Dermatology, New Haven, Connecticut; Department of Pathology, New Haven, Connecticut.
| |
Collapse
|
21
|
Update on vasculitis: an overview and dermatological clues for clinical and histopathological diagnosis - part I. An Bras Dermatol 2020; 95:355-371. [PMID: 32307202 PMCID: PMC7253914 DOI: 10.1016/j.abd.2020.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 01/19/2020] [Indexed: 11/22/2022] Open
Abstract
The term vasculitis refers to the inflammation of vessel walls. It may range in severity from a self-limited disorder in one single organ to a life-threatening disease due to multiple organ failure. It has many causes, although they result in only a few histological patterns of vascular inflammation. Vessels of any type and in any organ can be affected, a fact that results in a broad variety of signs and symptoms. Different vasculitides with indistinguishable clinical presentations have quite different prognosis and treatments. This condition presents many challenges to physicians in terms of classification, diagnosis, appropriate laboratory workup, and treatment. Moreover, it compels a careful follow-up. This article reviews the Chapel-Hill 2012 classification, etiology, recent insights in pathophysiology, some important dermatological clues for the diagnosis and summarizes treatment of some of these complex vasculitis syndromes.
Collapse
|
22
|
Song IG, Jung KU, Kim HO, Kim H, Chun HK. An Unusual Case of Colon Perforation With Multiple Transmural Ulcers After Use of Polmacoxib and Everolimus in a Metastatic Breast Cancer Patient. Ann Coloproctol 2020; 37:120-124. [PMID: 32178492 PMCID: PMC8134926 DOI: 10.3393/ac.2019.08.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/17/2019] [Indexed: 11/15/2022] Open
Abstract
Everolimus (Afinitor) is an inhibitor of mammalian target of rapamycin. Polmacoxib (Acelex) is a nonsteroidal anti-inflammatory drug that belongs to the cyclooxygenase-2 (COX-2) inhibitor family and is mainly used for treatment of arthritis. Intestinal perforation has not been reported previously as a complication of everolimus, and perforation of the lower intestinal tract caused by a selective COX-2 inhibitor is extremely rare. We present here a case of colon perforation that occurred after use of polmacoxib in a metastatic breast cancer patient who had been treated with everolimus for the preceding six months.
Collapse
Affiliation(s)
- In-Gyu Song
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Nico MMS, Pinto NT, Lourenço SV. From strawberry gingivitis to palatal perforation: The clinicopathological spectrum of oral mucosal lesions in granulomatosis with polyangiitis. J Oral Pathol Med 2020; 49:443-449. [PMID: 32133698 DOI: 10.1111/jop.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reports of oral manifestations of granulomatosis with polyangiitis (GPA) usually refer to single-case reports; "strawberry gingivitis" has been increasingly reported. OBJECTIVE To study the clinicopathological findings of four patients in which the diagnosis of GPA was suspected from the observation of their oral lesions and compare these to existent data. METHODS Retrospective study of a case series. RESULTS One patient presented typical "strawberry gingivitis" with localized disease and negative ANCA results. Two patients presented rapidly growing oral ulcers associated with systemic compromise and high ANCA levels. One patient presented with a chronic granulomatous lesion that leaded to palatal perforation. CONCLUSION Oral manifestations of GPA may vary from rapidly evolving lesions in acutely ill patients to chronic and locally destructive lesions in slowing developing disease. These differences are also evident in the histopathological findings.
Collapse
Affiliation(s)
| | - Nathalia Targa Pinto
- Department of Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
24
|
Koch M, Khan Z, Karle EM, Patel TP. Immune complex vasculitis: a rash that cannot be missed. BMJ Case Rep 2020; 13:13/2/e233545. [PMID: 32034001 DOI: 10.1136/bcr-2019-233545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Michelle Koch
- School of Medicine, University of Missouri System, Columbia, Missouri, USA
| | - Zalan Khan
- Department of Neurology, University of Missouri System, Columbia, Missouri, USA
| | - Ethan M Karle
- Department of Medicine, University of Missouri System, Columbia, Missouri, USA
| | - Tarang P Patel
- Department of Medicine, University of Missouri System, Columbia, Missouri, USA
| |
Collapse
|
25
|
Bezerra AS, Polimanti AC, de Oliveira RA, Fürst RVDC, Criado PR, Corrêa JA. Early diagnosis and treatment of Leukocytoclastic Vasculitis: case report. J Vasc Bras 2020; 19:e20180072. [PMID: 31975988 PMCID: PMC6956624 DOI: 10.1590/1677-5449.190072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 46-year-old female patient presented at the emergency department of a Municipal University Hospital with necrotic lesions in lower limbs associated with wasting syndrome. She was diagnosed with leukocytoclastic vasculitis after physical examination and history-taking in a fast and cost-effective manner, using an algorithm specifically for primary vasculitis, enabling early and appropriate treatment. The good clinical outcome demonstrates the need to quickly make a definitive diagnosis and start treatment.
Collapse
Affiliation(s)
- Alexandre Sacchetti Bezerra
- Faculdade de Medicina do ABC, Santo André, SP, Brasil.,Sociedade Brasileira de Angiologia e Cirurgia Vascular - SBACV, São Paulo, SP, Brasil
| | | | | | | | | | | |
Collapse
|
26
|
Tawanwongsri W, Chayavichitsilp P. Methimazole-Induced Leukocytoclastic Vasculitis: A Case Report. Case Rep Dermatol 2019; 11:303-309. [PMID: 31762745 PMCID: PMC6873099 DOI: 10.1159/000503990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 11/25/2022] Open
Abstract
Major identifiable causes of leukocytoclastic vasculitis include certain infections and medications. Amongst antithyroid drugs, methimazole (MMI) is rarely implicated as a culprit drug. We report the first case, in Thailand, of MMI-induced leukocytoclastic vasculitis in a 41-year-old Thai female who had received MMI for relapsed Graves' disease. MMI was discontinued and cholestyramine at a dose of 4 g four times daily was given instead. Her rashes on both legs resolved dramatically at 1-week follow-up. However, thyroid function test revealed unimproved thyrotoxicosis. She subsequently underwent radioiodine ablation as a definitive treatment. There were neither recurrent skin lesions nor other systemic involvements during the 3-month follow-up period. Notably, the most crucial step in the management of drug-induced leukocytoclastic vasculitis is the discontinuation of the offending drug in order to avoid further progression of the disease. The administration of immunosuppressive agents may not be necessary in patients with mild severity and non-vital organ involvement.
Collapse
Affiliation(s)
| | - Pamela Chayavichitsilp
- *Pamela Chayavichitsilp, MD, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400 (Thailand), E-Mail
| |
Collapse
|
27
|
Woodford RG, Becker GJ, Jain A. Leukocytoclastic vasculitis associated with use of aromatase inhibitors. Intern Med J 2019; 49:1162-1167. [PMID: 31507048 DOI: 10.1111/imj.14422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
Abstract
Leukocytoclastic vasculitis is an uncommon but important complication of aromatase inhibitor use which may have cosmetic and systemic ramifications. We present a case in which this reaction was observed and aim to compare the characteristics of patients and trajectory of disease in order to assist with early identification and treatment.
Collapse
Affiliation(s)
| | - Gerrie J Becker
- Coffs Coast Dermatology, Coffs Harbour, New South Wales, Australia
| | - Ankit Jain
- Mid-North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| |
Collapse
|
28
|
Abstract
Hemorrhagic rashes are observed in a wide variety of conditions, ranging from harmless to life-threatening. This review offers a stepwise approach, which helps limit the possible differential diagnoses based on the clinical manifestations and the clinical picture. The most common and most important conditions, including infectious, coagulation and embolic disorders, vasculitides, and vasculopathies, are briefly reviewed focusing on morphology. Dermatologists often need to distinguish among infectious, reactive, or autoimmune etiologies of the rash and determine if the condition is dangerous or even life-threatening in order to make the right decision. Dermatologic expertise provides vital input in the diagnosis and care of complex interdisciplinary patients, such as those with sepsis, purpura fulminans, and thrombotic thrombocytopenic purpura.
Collapse
|
29
|
Zhong CS, Yu SH, Cornejo KM, Chen ST. Woman with Fatigue, Peripheral Neuropathy, Lower Extremity Edema, and Palpable Purpura: Type II Cryoglobulinemia. Am J Med 2019; 132:936-939. [PMID: 30904513 DOI: 10.1016/j.amjmed.2019.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - Sherry H Yu
- Harvard Combined Dermatology Residency, Boston, Mass; Department of Dermatology, Massachusetts General Hospital, Boston
| | | | - Steven T Chen
- Harvard Medical School, Boston, Mass; Department of Dermatology, Massachusetts General Hospital, Boston; Department of Internal Medicine, Massachusetts General Hospital, Boston.
| |
Collapse
|
30
|
Difficult Differential Diagnosis of Hemorrhagic Vasculitis in the Practice of General Physician-family Practitioner: Own Clinical Observations and Literature Data. Fam Med 2019. [DOI: 10.30841/2307-5112.2.2019.174727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
31
|
Temiz SA, Ataseven A, Ozer I, Dursun R, Findik S. Refractory Urticarial Vasculitis Responsive to Methotrexate: Could It Be a New Treatment Option? CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/marusbed.546841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
32
|
Abstract
Cutaneous vasculitis, inflammatory destruction of blood vessels, can present with a wide range of clinical and pathologic findings across a number of heterogeneous conditions. Although some vasculitides are present in both children and adults, some important differences exist in clinical presentation, etiology, management, and prognosis in childhood vasculitis versus adult vasculitis. Cutaneous vasculitis is rare in children, and most childhood vasculitides, of which Henoch-Schönlein purpura is the most common, histologically are small vessel leukocytoclastic vasculitis. In children, infectious etiologies are more common than in adults. Childhood cutaneous vasculitis is most often self-limited with a good prognosis, and treatment is mainly supportive. © 2017 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
| | | |
Collapse
|
33
|
Cutaneous leukocytoclastic vasculitis: the role of lymphocytes and related immune markers. Postepy Dermatol Alergol 2017; 34:299-305. [PMID: 28951703 PMCID: PMC5560176 DOI: 10.5114/ada.2017.69307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Apart from neutrophils, other immune cells may play a significant pathogenetic role in cutaneous leukocytoclastic vasculitis (CLV). AIM To investigate lymphocytes and related immunological factors in patients with CLV requiring systemic glucocorticosteroid treatment. MATERIAL AND METHODS Fourteen patients with severe idiopathic CLV were treated with systemic prednisolone in a tapered dose regimen. Ten healthy individuals served as controls. At baseline and post-treatment, we studied inducer/helper and suppressor/cytotoxic T lymphocytes, B lymphocytes, natural killer cells, CD4+CD25++CD127- cells, CD4+CD25+CD39+ cells and FOXP3, transforming growth factor β1 (TGF-β1) and interleukin-10 (IL-10) mRNA levels in the blood using flow cytometry and real time polymerase chain reaction (RT-PCR), respectively. On immunohistochemistry, we studied CD4, CD8, granzyme B, TGF-β1, and IL-10. RESULTS Flow cytometry did not show significant differences. The RT-PCR revealed that TGF-β1 mRNA expression was significantly higher after therapy when compared to baseline and controls. On immunohistology, baseline CLV lesions showed significantly more CD4+ lymphocytes than post-treated CLV and controls. CD8+ expression was significantly higher after therapy when compared to baseline and controls. Baseline granzyme B was significantly increased when compared to treated CLV and controls. The IL-10 expression of treated CLV was significantly increased when compared to baseline CLV and; baseline CLV IL-10 expression was significantly increased as compared to controls. CONCLUSIONS Circulating T regulatory cells do not play a significant role in the pathogenesis of CLV. T helper cells and granzyme B seem to be involved in the inflammatory cutaneous process of CLV. A resolution of CLV observed after glucocorticosteroid treatment may be mediated via up-regulation of TGF-β1 and IL-10 in different compartments.
Collapse
|
34
|
Demographic characteristics, aetiology, and assessment of treatment options in leukocytoclastic vasculitis. Postepy Dermatol Alergol 2017; 34:104-109. [PMID: 28507487 PMCID: PMC5420600 DOI: 10.5114/ada.2017.67071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 03/03/2016] [Indexed: 01/10/2023] Open
Abstract
Introduction Vasculitides are a heterogeneous group of diseases characterized by inflammation of the blood vessel walls. Etiological factors include infections, drugs, connective tissue diseases, and malignancies. Aim To examine the demographic characteristics, etiological factors, and treatment options in 75 patients with leukocytoclastic vasculitis. Material and methods The study included 75 patients diagnosed with leukocytoclastic vasculitis at our clinic. The patients’ medical records were reviewed to determine their age, sex, presence of systemic symptoms, possible etiological factors, laboratory results, types of cutaneous lesions, locations of the lesions, treatment options, and disease course. Results There were 43 women and 32 men. Cutaneous lesions affected only the lower limbs in 60 of the 75 patients (80%) and usually presented as palpable purpura (64%, n = 48). Arthralgia (26.7%, n = 20) was the most frequent extracutaneous symptom. Of the patients with secondary vasculitis, the most common causes were infections and drugs. The mean age of the patients with Henoch-Schönlein purpura was 26.8 years. There was no significant association between age and renal, gastrointestinal, or joint involvement. Conclusions The most common form of vasculitis in our study was cutaneous leukocytoclastic vasculitis. In most of the patients it appeared to be idiopathic. Among drugs, antibiotics were the most common etiological factor. In 4 patients, the cutaneous leukocytoclastic vasculitis behaved like the paraneoplastic syndrome.
Collapse
|
35
|
Arakaki R, Fox L. Updates in the Approach to the Patient with Purpura. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
Abstract
Drug-induced leukocytoclastic vasculitis is a small-vessel vasculitis that most commonly manifests with palpable purpuric lesions on gravity-dependent areas. Vasculitis occurs within weeks after initial administration of medication and demonstrates clearance upon withdrawal of medication. Levetiracetam, a pyrrolidone derivative, is used as an adjunctive therapy in patients with refractory focal epilepsy, myoclonic epilepsy, and primary generalized tonic–clonic seizures. We present a case of a 14-year-old female, who developed cutaneous small-vessel vasculitis within 8 days of initiation of levetiracetam. Vasculitis was successfully managed by discontinuation of medication and systemic corticosteroids. This adverse reaction, to the best of our knowledge, has not been previously reported in literature.
Collapse
Affiliation(s)
- Mrinal Gupta
- Treatwell Skin Centre, Jammu, Jammu and Kashmir, India
| |
Collapse
|
37
|
Wee E, Kelly RI. The histopathology of cutaneous polyarteritis nodosa and its relationship with lymphocytic thrombophilic arteritis. J Cutan Pathol 2017; 44:411. [DOI: 10.1111/cup.12901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Edmund Wee
- Department of DermatologySt Vincent's Hospital Melbourne VIC Australia
| | - Robert I. Kelly
- Department of DermatologySt Vincent's Hospital Melbourne VIC Australia
| |
Collapse
|
38
|
An J, Garje R, Wanat KA, Leone JP. Dabigatran-related leukocytoclastic vasculitis. BMJ Case Rep 2017; 2017:bcr-2016-217423. [PMID: 28052946 DOI: 10.1136/bcr-2016-217423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dabigatran is a non-vitamin K antagonist oral anticoagulant that has been approved for atrial fibrillation and prevention of venous thromboembolism. Its use has been increasing in the USA since serum drug levels do not need monitoring. To date, no significant skin side effects have been reported other than 4 cases of non-specific skin lesion and 2 cases of leukocytoclastic vasculitis (LCV), which is a small vessel inflammatory disease that presents as palpable purpura in lower extremities. We present a man aged 57 years with chronic deep vein thrombosis who developed palpable purpura, petechiae, swelling in lower extremities, torso and distal upper extremities on the third day after dabigatran initiation. The present case highlights the potential risk for LCV with dabigatran use and provides insight into its management.
Collapse
Affiliation(s)
- Josiah An
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rohan Garje
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - José Pablo Leone
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
39
|
Kazandjieva J, Antonov D, Kamarashev J, Tsankov N. Acrally distributed dermatoses: Vascular dermatoses (purpura and vasculitis). Clin Dermatol 2016; 35:68-80. [PMID: 27938815 DOI: 10.1016/j.clindermatol.2016.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpuric lesions appear in acral distribution in a variety of conditions and often provide clues to the clinical diagnosis. Purpuric means "hemorrhagic"-that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex-mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. The hallmark of pigmented purpuric dermatoses is their orange-brown, speckled, cayenne pepper-like discoloration.
Collapse
Affiliation(s)
- Jana Kazandjieva
- Department of Dermatology and Venereology, Medical University Sofia, Sofia, Bulgaria.
| | - Dimitar Antonov
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Jivko Kamarashev
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Nikolai Tsankov
- Department of Dermatology and Venereology, Tokuda Hospital Sofia, Sofia, Bulgaria
| |
Collapse
|
40
|
Zanoni G, Girolomoni G, Bonetto C, Trotta F, Häusermann P, Opri R, Bonhoeffer J. Single organ cutaneous vasculitis: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6561-6571. [PMID: 28029543 DOI: 10.1016/j.vaccine.2016.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | | | - Roberta Opri
- Immunology Unit, University Hospital, Verona, Italy
| | - Jan Bonhoeffer
- University Basel Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
| | | |
Collapse
|
41
|
Fathallah N, Ladhari C, Slim R, Ghariani N, Sriha B, Ben Salem C. Vasculitis induced by phenobarbital with cross-reactivity to carbamazepine. Therapie 2016; 72:387-389. [PMID: 27717500 DOI: 10.1016/j.therap.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Neila Fathallah
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia.
| | - Chayma Ladhari
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
| | - Raoudha Slim
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
| | - Najet Ghariani
- Farhat-Hached University Hospital, Department of dermatology, 4002 Sousse, Tunisia
| | - Badreddine Sriha
- Farhat-Hached University Hospital, Anatomo-cytopathology department, Sousse, Tunisia
| | - Chaker Ben Salem
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
| |
Collapse
|
42
|
Johnson EF, Wetter DA, Lehman JS, Hand JL, Davis DMR, Tollefson MM. Leukocytoclastic vasculitis in children: clinical characteristics, subtypes, causes and direct immunofluorescence findings of 56 biopsy-confirmed cases. J Eur Acad Dermatol Venereol 2016; 31:544-549. [PMID: 27580419 DOI: 10.1111/jdv.13952] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leukocytoclastic vasculitis (LCV) in children is a complex group of conditions. OBJECTIVES This study presents the demographics, clinical features, direct immunofluorescence (DIF) results and suspected aetiologies of 56 biopsy-confirmed cases of leukocytoclastic vasculitis in children. METHODS Retrospective review of 56 children seen at Mayo Clinic in Rochester, Minnesota, from 1993 to 2013 with clinical features and cutaneous biopsy consistent with LCV. RESULTS Twenty-seven (48%) cases were found to be due to IgA vasculitis (Henoch-Schonlein purpura). The remaining cases were found to be due to cutaneous small-vessel vasculitis (n = 19, 34%), urticarial vasculitis (n = 5, 9%), ANCA-associated vasculitis (n = 4, 7%) and acute haemorrhagic oedema of infancy (n = 1, 2%). IgA vasculitis was found to be associated with abdominal pain (P = 0.008), whereas the non-IgA vasculitis group was associated with headache (P = 0.052). Children with IgA vasculitis had palpable purpura (P = <0.001), petechia (P = 0.057), vesicles (P = 0.009) and involvement of the buttock (P = 0.004) more frequently than the non-IgA vasculitis group. On DIF, perivascular IgA was positive in IgA vasculitis compared to non-IgA vasculitis cases (P = <0.001), the other conjugates were similar between the two groups. CONCLUSION The most common subtype of biopsy-confirmed LCV in children is IgA vasculitis. Clinical features, exam characteristics and DIF results can be helpful in determining the subtype of cutaneous vasculitis in children.
Collapse
Affiliation(s)
- E F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - D A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - J S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - J L Hand
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Mayo Clinic, Rochester, MN, USA.,Department of Medical Genetics, Mayo Clinic, Rochester, MN, USA
| | - D M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - M M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
43
|
Liu M, Chen Z, Zabihian B, Sinz C, Zhang E, Beard PC, Ginner L, Hoover E, Minneman MP, Leitgeb RA, Kittler H, Drexler W. Combined multi-modal photoacoustic tomography, optical coherence tomography (OCT) and OCT angiography system with an articulated probe for in vivo human skin structure and vasculature imaging. BIOMEDICAL OPTICS EXPRESS 2016; 7:3390-3402. [PMID: 27699106 PMCID: PMC5030018 DOI: 10.1364/boe.7.003390] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/28/2016] [Accepted: 08/09/2016] [Indexed: 05/05/2023]
Abstract
Cutaneous blood flow accounts for approximately 5% of cardiac output in human and plays a key role in a number of a physiological and pathological processes. We show for the first time a multi-modal photoacoustic tomography (PAT), optical coherence tomography (OCT) and OCT angiography system with an articulated probe to extract human cutaneous vasculature in vivo in various skin regions. OCT angiography supplements the microvasculature which PAT alone is unable to provide. Co-registered volumes for vessel network is further embedded in the morphologic image provided by OCT. This multi-modal system is therefore demonstrated as a valuable tool for comprehensive non-invasive human skin vasculature and morphology imaging in vivo.
Collapse
Affiliation(s)
- Mengyang Liu
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| | - Zhe Chen
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| | - Behrooz Zabihian
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| | - Christoph Sinz
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, AKH 7J, Vienna, 1090, Austria
| | - Edward Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
| | - Paul C. Beard
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
| | - Laurin Ginner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| | - Erich Hoover
- INSIGHT Photonic Solutions, Inc., 300 S. Public Road, Lafayette, CO, 80026, USA
| | - Micheal P. Minneman
- INSIGHT Photonic Solutions, Inc., 300 S. Public Road, Lafayette, CO, 80026, USA
| | - Rainer A. Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, AKH 7J, Vienna, 1090, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, Vienna, 1090, Austria
| |
Collapse
|
44
|
Complement C3 is expressed by mast cells in cutaneous vasculitis and is degraded by chymase. Arch Dermatol Res 2016; 308:575-84. [PMID: 27465068 DOI: 10.1007/s00403-016-1677-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/16/2016] [Accepted: 07/13/2016] [Indexed: 02/04/2023]
Abstract
The complement factor C3 and chymase released from tryptase(+), chymase(+) mast cells may be involved in the pathogenesis of cutaneous leukocytoclastic vasculitis. To study whether mast cells contain C3 in vasculitis and whether chymase interacts with C3, cryosections from vasculitis biopsies were double-stained histochemically for C3c in tryptase(+) mast cells, as well as for chymase and vessel wall C3c, or they were treated with 5 µg/ml rh-chymase for 24 h followed by immunofluorescence (IF) analysis of C3c, IgG, IgM and IgA. The effect of rh-chymase on purified human C3, C3a and IgG was studied using SDS-PAGE electrophoresis and LAD2 mast cell cultures. The results show that 34.2 ± 17.9, 37.4 ± 15.5 and 43.4 ± 18.6 % (mean ± SD) of the mast cells express C3c immunoreactivity in the healthy skin, initial petechial (IP) and palpable purpura (PP) lesions, respectively. About 9.4-12.1 % of the chymase(+) mast cells were in apparent contact with C3c(+) vessels in IP and PP. The treatment of cryosections with rh-chymase decreased the IF staining of C3c, but not that of immunoglobulins. In SDS-PAGE, 1-10 µg/ml rh-chymase degraded the alpha- and beta-chains of C3, but did not degrade IgG. Unexpectedly, the rh-chymase treatment of C3 produced fragments that resulted in the release of tryptase and histamine from LAD2 cells. However, rh-chymase degraded C3a and consequently inhibited C3a activity on LAD2. In conclusion, mast cells can be one source for C3 in the early and late phases of vasculitis pathogenesis. However, rh-chymase degraded native C3, vessel wall C3c, and biologically active C3a. Therefore, chymase may control C3-related pathology.
Collapse
|
45
|
Jumean K, Arqoub AA, Hawatmeh A, Qaqa F, Bataineh A, Shaaban H. Warfarin-induced leukocytoclastic vasculitis and proteinuria. J Family Med Prim Care 2016; 5:160-2. [PMID: 27453863 PMCID: PMC4943126 DOI: 10.4103/2249-4863.184643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Warfarin is typically prescribed for patients with thromboembolic diseases and atrial fibrillation. In addition to the complications of bleeding, allergic skin reaction is one of its rare adverse effects. We herein report a case of a 79 year old male patient with leukocytoclastic vasculitis and proteinuria secondary to warfarin. The warfarin was discontinued and oral prednisone therapy was initiated. The cutaneous lesions and the proteinuria resolved thereafter.
Collapse
Affiliation(s)
- Khalid Jumean
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| | - Ahmad Abu Arqoub
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| | - Amer Hawatmeh
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| | - Firas Qaqa
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| | - Ayham Bataineh
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| | - Hamid Shaaban
- Department of Internal Medicine, Hematology and Oncology, St Michael's Medical Center, Newark, NJ 07102, USA
| |
Collapse
|
46
|
Bouiller K, Audia S, Devilliers H, Collet E, Aubriot MH, Leguy-Seguin V, Berthier S, Bonniaud P, Chavanet P, Besancenot JF, Vabres P, Martin L, Samson M, Bonnotte B. Etiologies and prognostic factors of leukocytoclastic vasculitis with skin involvement: A retrospective study in 112 patients. Medicine (Baltimore) 2016; 95:e4238. [PMID: 27428231 PMCID: PMC4956825 DOI: 10.1097/md.0000000000004238] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, outcomes of patients with leukocytoclastic vasculitis (LCV) were analyzed focusing on clinical, histopathology and laboratory findings, relapses, and survival.Data from patients with cutaneous vasculitis diagnosed between January 1, 2000, and December 31, 2010, at Dijon University Hospital (France) were retrospectively reviewed. LCV was defined as perivascular neutrophilic infiltrate, endothelial cell nuclear swelling, extravasation of red blood cells, and/or fibrin deposition in vessels. Patients were classified according to the 2012 Chapel Hill Consensus Conference. Relapses were defined as the recurrence of vasculitis symptoms after a period of remission >1 month. Time to relapse and/or death was calculated from the date of diagnosis. Univariate and multivariate (Cox model) analyses were performed.A total of 112 patients (57 males and 55 females), with a mean age of 60 ± 19 (18-98) years, were analyzed. Overall follow-up was 61 ± 38 months. At diagnosis, all patients had skin lesions, purpura being the most common (n = 83). Lesions were associated with systemic involvement in 55 (51%) patients. Only 41 (36.6%) patients received specific treatment: glucocorticoids in 29 of 41 (70.7%) and immunosuppressants in 9 of 41 (22%). Sixty-two patients (55%) had LCV due to underlying causes, 29 (25.9%) had single-organ cutaneous small vessel vasculitis (SoCSVV), and 21 (18.8%) had unclassifiable LCV. Twenty patients of the cohort (18%) experienced relapse, 14 ± 13 (1-40) months after the diagnosis of LCV. None of the 29 patients with SoCSVV relapsed. Independent risk factors for relapse were vascular thrombosis in the biopsy [hazard ratio (HR) = 4.9; P = 0.017], peripheral neuropathy (HR = 9.8; P = 0.001), hepatitis (HR = 3.1; P = 0.004), and positive antineutrophil cytoplasm antibodies (ANCA, HR = 5.9 P = 0.005). In contrast, SoCSVV was a protective factor for relapse (HR = 0.12; P = 0.043).The 1-, 3-, and 6-year overall survival rates were 99%, 83%, and 71%, respectively, with no difference between relapsers and nonrelapsers (P = 0.960) or between SoCSVV and unclassifiable LCV (P = 0.588).This study demonstrates that global survival for LCV patients is good but relapses remain frequent, especially when the cutaneous biopsy shows vascular thrombosis, or in patients with peripheral neuropathy or hepatitis. Conversely, SoCSVV is a protective factor for relapse.
Collapse
Affiliation(s)
- Kévin Bouiller
- Service de médecine interne et immunologie clinique Service de médecine interne et maladies systémiques Service de dermatologie Laboratoire d'anatomopathologie Service de pneumologie Service de maladies infectieuses, CHU François Mitterrand, Dijon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Leukocytoclastic vasculitis (LCV), also termed hypersensitivity vasculitis, is a small-vessel vasculitis. The skin is the organ most commonly involved in LCV. Typical presentation is a painful, burning rash predominantly in the lower extremities. The most common skin manifestation is palpable purpura. Other skin manifestations include maculopapular rash, bullae, papules, plaques, nodules, ulcers, and livedo reticularis.
Collapse
Affiliation(s)
- Joseph Einhorn
- Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in CA.
| | - Joel T Levis
- Senior Emergency Physician at the Santa Clara Medical Center, and Clinical Assistant Professor of Emergency Medicine (Surgery) at Stanford University. He is the Medical Director for the Foothill College Paramedic Program in Los Altos, CA.
| |
Collapse
|
48
|
Morton LM, Phillips TJ. Wound healing and treating wounds. J Am Acad Dermatol 2016; 74:589-605; quiz 605-6. [DOI: 10.1016/j.jaad.2015.08.068] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/03/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
|
49
|
Xue Y, Cohen JM, Wright NA, Merola JF. Skin Signs of Rheumatoid Arthritis and its Therapy-Induced Cutaneous Side Effects. Am J Clin Dermatol 2016; 17:147-62. [PMID: 26649439 DOI: 10.1007/s40257-015-0167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that primarily affects the joints, but may exhibit extra-articular, including cutaneous, manifestations such as rheumatoid nodules, rheumatoid vasculitis, granulomatous skin disorders, and neutrophilic dermatoses. A large burden of cutaneous disease may be an indication of RA disease activity and the need for more aggressive treatment. Many of the therapeutic agents used to treat RA can also result in cutaneous adverse effects, which pose their own diagnostic and therapeutic challenges. Anti-TNFα agents, in particular, have a wide variety of adverse effects including psoraisiform eruptions, granulomatous conditions, and cutaneous connective tissue disorders. Herein we provide an update on the clinical presentations and management of RA-associated cutaneous findings as well as drug-induced cutaneous effects, with particular attention to the adverse effects of biologic disease-modifying agents.
Collapse
|
50
|
Mast cell tryptase and chymase in the progress of cutaneous vasculitis. Arch Dermatol Res 2015; 307:917-24. [DOI: 10.1007/s00403-015-1607-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
|