Vasculitis

Diagnosis: Vasculitis

Case submitted by Shahbaz A. Janjua to the dermRounds community.

Clinical Presentation

Clinical photograph(s) submitted for peer review and discussion.

Clinical History

Submitted by Shahbaz A. Janjua. Originally posted March 10, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Thrombocytopenic purpura • Drug eruption • Disseminated intravascular coagulation • Cellulitis • Septic emboli • Cholesterol emboli • Pigmented purpuric dermatosis

Key Learnings

• Palpable purpura is the hallmark of small-vessel vasculitis (leukocytoclastic vasculitis) • IgA vasculitis (Henoch-Schönlein purpura): most common vasculitis in children — IgA deposits • IgA vasculitis tetrad: palpable purpura, arthralgia, abdominal pain, renal involvement • Histology: fibrinoid necrosis of vessel walls with neutrophilic infiltrate and nuclear dust (leukocytoclasis) • DIF: IgA deposits in vessel walls (IgA vasculitis) • Evaluate for underlying cause: infection (HBV, HCV, strep), drugs, CTD, malignancy • ANCA-associated vasculitis: GPA (c-ANCA/PR3), MPA (p-ANCA/MPO), EGPA

Tags: vasculitis, shahbaz a. janjua