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leukocytoclastic vasculitis; hypersensitivity vasculitis; trisymptome; immune complex-mediated vasculitis

Etiology: 1) autoimmune disease - systemic lupus erythematosus 2) recent viral infection - hepatitis C, cryoglobulinemia 3) malignancy - lymphoproliferative disorders 4) drug adverse effect 5) systemic vasculitis 6) idiopathic (40%) [1] Clinical manifestations: - palpable purpura in small bunches over the lower extremities & buttocks - cutaneous vesicles, pustules, maculopapular lesions, urticaria - occurs within 2 weeks of exposure to offending agent - 50% of cases, the offending agent is unknown - generally resolves when the offending agent is removed [1] Laboratory: - skin biopsy - neutrophilic infiltrate of small vessels, leukocytoclasia, & fibrinoid necrosis - direct immunofluorescence reveals only scant deposits of C3, IgM, IgA, & IgG Differential diagnosis: - exanthematous drug eruption (morbilliform exanthem) - immune thrombocytopenic purpura - petechiae/purpura of thrombocytopenia are not palpable - IgA vasculitis: - dominant IgA pattern of immunoglobulin deposition vessels - systemic features (renal. GI, joint) Management: 1) generally self-limited - withdrawal of offending agent 2) glucocorticoids 3) see acute leukocytoclastic vasculitis (Henoch-Schonlein purpura) or specific etiology

Interactions

disease interactions

Related

cryoglobulinemia (cryoglobulinemic vasculitis) leukocytoclasis serum sickness; serum sickness-like reaction

Specific

acute leukocytoclastic vasculitis (Henoch-Schonlein purpura; IgA vasculitis) chronic leukocytoclastic vasculitis (Gougerot-Ruiter type) cutaneous leukocytoclastic vasculitis urticarial vasculitis

General

type 3 hypersensitivity; immune complex hypersensitivity vasculitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018. 2022. - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Eastham ABW, Diamond HS (images) Medscape: Leukocytoclastic Vasculitis. http://emedicine.medscape.com/article/333891-overview
  3. Kroshinsky D Adverse cutaneous reactions to medications Clin Dermatol. 2020 Nov-Dec;38(6):605-606 PMID: 33341194
  4. Fraticelli P, Benfaremo D, Gabrielli A. Diagnosis and management of leukocytoclastic vasculitis. Intern Emerg Med. 2021;16:831-841. PMID: 33713282