Cargando…

Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference

Leukocytoclastic vasculitis (LCV) is an uncommon condition with a broad differential diagnosis. Although the clinical history, physical examination, and laboratory workup are pivotal when formulating a differential diagnosis of LCV, a skin biopsy is required in most cases to elucidate the cause. The...

Descripción completa

Detalles Bibliográficos
Autores principales: Chango Azanza, Juan Jose, Calle Sarmiento, Paola Michelle, Lopetegui Lia, Nerea, Alexander, Swetha Ann, Modi, Viraj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263727/
https://www.ncbi.nlm.nih.gov/pubmed/32494527
http://dx.doi.org/10.7759/cureus.7912
_version_ 1783540843399872512
author Chango Azanza, Juan Jose
Calle Sarmiento, Paola Michelle
Lopetegui Lia, Nerea
Alexander, Swetha Ann
Modi, Viraj
author_facet Chango Azanza, Juan Jose
Calle Sarmiento, Paola Michelle
Lopetegui Lia, Nerea
Alexander, Swetha Ann
Modi, Viraj
author_sort Chango Azanza, Juan Jose
collection PubMed
description Leukocytoclastic vasculitis (LCV) is an uncommon condition with a broad differential diagnosis. Although the clinical history, physical examination, and laboratory workup are pivotal when formulating a differential diagnosis of LCV, a skin biopsy is required in most cases to elucidate the cause. The diagnostic yield of a skin biopsy increases within the first 24 to 48 hours of the lesion onset indicating the importance of obtaining a prompt skin sample. We present the case of a 60-year-old man who presented to the emergency department with a three-day history of fevers, headaches, and a painful skin rash. He endorsed rhinorrhea and sore throat a week ago. Physical examination was notable for an erythematous papular rash with palpable violaceous purpura located mainly at the distal right leg and thigh. He also complained of painful bilateral hand edema. His complete blood count and chemistries were unremarkable. His C-reactive protein was 147 mg/L (normal value <8 mg/L), and sedimentation rate was 51 mm (normal value <15 mm). Immunoglobulin A was 509 mg/dL (normal value 82-460 mg/dL). Further workup including viral hepatitis serologies, antinuclear antibodies, complements, antineutrophil cytoplasmic antibodies, cryoglobulins, rheumatoid factor, and blood cultures yielded negative results. Therefore, it was believed that his rash was likely associated with his recent upper respiratory infection. A skin biopsy done on the first day of admission was positive for LCV without immunoglobulin A deposition. He was managed with prednisone and anti-inflammatory medications with improvement of his rash.
format Online
Article
Text
id pubmed-7263727
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-72637272020-06-02 Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference Chango Azanza, Juan Jose Calle Sarmiento, Paola Michelle Lopetegui Lia, Nerea Alexander, Swetha Ann Modi, Viraj Cureus Dermatology Leukocytoclastic vasculitis (LCV) is an uncommon condition with a broad differential diagnosis. Although the clinical history, physical examination, and laboratory workup are pivotal when formulating a differential diagnosis of LCV, a skin biopsy is required in most cases to elucidate the cause. The diagnostic yield of a skin biopsy increases within the first 24 to 48 hours of the lesion onset indicating the importance of obtaining a prompt skin sample. We present the case of a 60-year-old man who presented to the emergency department with a three-day history of fevers, headaches, and a painful skin rash. He endorsed rhinorrhea and sore throat a week ago. Physical examination was notable for an erythematous papular rash with palpable violaceous purpura located mainly at the distal right leg and thigh. He also complained of painful bilateral hand edema. His complete blood count and chemistries were unremarkable. His C-reactive protein was 147 mg/L (normal value <8 mg/L), and sedimentation rate was 51 mm (normal value <15 mm). Immunoglobulin A was 509 mg/dL (normal value 82-460 mg/dL). Further workup including viral hepatitis serologies, antinuclear antibodies, complements, antineutrophil cytoplasmic antibodies, cryoglobulins, rheumatoid factor, and blood cultures yielded negative results. Therefore, it was believed that his rash was likely associated with his recent upper respiratory infection. A skin biopsy done on the first day of admission was positive for LCV without immunoglobulin A deposition. He was managed with prednisone and anti-inflammatory medications with improvement of his rash. Cureus 2020-05-01 /pmc/articles/PMC7263727/ /pubmed/32494527 http://dx.doi.org/10.7759/cureus.7912 Text en Copyright © 2020, Chango Azanza et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Dermatology
Chango Azanza, Juan Jose
Calle Sarmiento, Paola Michelle
Lopetegui Lia, Nerea
Alexander, Swetha Ann
Modi, Viraj
Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title_full Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title_fullStr Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title_full_unstemmed Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title_short Leukocytoclastic Vasculitis: An Early Skin Biopsy Makes a Difference
title_sort leukocytoclastic vasculitis: an early skin biopsy makes a difference
topic Dermatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263727/
https://www.ncbi.nlm.nih.gov/pubmed/32494527
http://dx.doi.org/10.7759/cureus.7912
work_keys_str_mv AT changoazanzajuanjose leukocytoclasticvasculitisanearlyskinbiopsymakesadifference
AT callesarmientopaolamichelle leukocytoclasticvasculitisanearlyskinbiopsymakesadifference
AT lopeteguilianerea leukocytoclasticvasculitisanearlyskinbiopsymakesadifference
AT alexanderswethaann leukocytoclasticvasculitisanearlyskinbiopsymakesadifference
AT modiviraj leukocytoclasticvasculitisanearlyskinbiopsymakesadifference