Small vessel leukocytoclastic vasculitis

Small vessel leukocytoclastic vasculitis, also leukocytoclastic vasculitis (abbreviated LCV), is an inflammatory process of the small blood vessel.

General

• Most common cutaneous vasculitis.

Clinical:

• Palpable purpura, usu. lower extremity.

Microscopic

Features:

• Small upper dermis vessels with:
  1. Neutrophils.
     • Fragmentation of neutrophils (leukocytoclasia).
  2. Vessel damage: fibrin deposition (bright pink acellular stuff).

Has a very broad DDx:

1. Infectious:
   • Bacterial.
   • Viral.
   • Fungal.
2. Vasculitic disorders:
   • ANCA mediated vasculitides:
     • Wegener granulomatosis.
     • Churg-Strauss syndrome.
   • Henoch–Schönlein purpura.
   • Urticarial vasculitis.
3. Other:
   • Connective tissue disease, e.g. mixed connective tissue disease, SLE, rheumatoid arthritis.
   • Cryoglobulinemia - may be due to multiple myeloma, hepatitis C; have intravascular thrombi.
   • Paraneoplastic.
   • Drugs.

Image:

• LCA (ancavasculitis.com).
• LCA of the GI tract - several images (upmc.edu).

Stains

• PAS - look for fungus.

See also

• Vasculitides.