Cutaneous Signs of Vascular Disorders: Idiopathic Leukocytoclastic Vasculitis

April 2, 2004
Robert P. Blereau, MD

A 16-year-old girl was bothered byankle pain and “red spots” on herlower legs. These symptoms clearedin a few days without treatment. Sixweeks later, after returning from anall-day outing at a fair, she noticedthat the spots had reappeared (A)and hemorrhagic lesions had developedon the right ankle (B) and leftheel (C). After removing her shoes,the teenager felt severe pain in bothankles, particularly the right.

A 16-year-old girl was bothered byankle pain and "red spots" on herlower legs. These symptoms clearedin a few days without treatment. Sixweeks later, after returning from anall-day outing at a fair, she noticedthat the spots had reappeared (A)and hemorrhagic lesions had developedon the right ankle (B) and leftheel (C). After removing her shoes,the teenager felt severe pain in bothankles, particularly the rightUnable to walk, the patient wastaken to the emergency departmentthe following morning. She wasafebrile, had no other lesions or jointpain, and was taking no medications.The complete blood cell count andsedimentation rate were normal. Antinuclearantibody titer was negative.An elliptical incisional biopsywas performed on the large left heellesion, and an excisional biopsy wasdone on the purpuric lesion on thesame leg. Microscopically, both sitesrevealed small vascular structures,primarily capillaries, surrounded byabundant polymorphonuclear leukocytesand few eosinophils, evidencethat confirmed the diagnosis of leukocytoclasticvasculitis.Leukocytoclastic, or hypersensitivity,vasculitis is a neutrophilic inflammationof small blood vessels.1Symptoms may include purpura,malaise, myalgias, and fever; oligoarthritisor monarthritis is associatedwith 40% of cases.2 Three characteristicsare significant in making thisdiagnosis:

  • The purpura is nonblanching.
  • Purpuric patches are found on dependentareas of the body; symmetricdistribution on the legs, thighs, andbuttocks is typical.
  • Each macule is regular and approximatelycircular.

The course of leukocytoclasticvasculitis generally is benign. Thispatient was treated with oral prednisone,and her condition promptlyimproved.

References:

REFERENCES:


1.

Habif TP.

Clinical Dermatology: A Color Guide toDiagnosis and Therapy

. 3rd ed. St Louis: Mosby;1996:579-582.

2.

Olewiler SD. Photoclinic: leukocytoclastic vasculitis.

Consultant

. 1994;34:1482-1483.