Search

Leukocytoclastic vasculitis (LCV) refers to the histopathological changes observed in a common form of small vessel vasculitis that can affect skin and/or internal organs. LCV can be precipitated by several causes (including infections, drugs, and collagen vascular diseases) or can be idiopathic. We report a 50-year-old man who presented with fever, parotid enlargement and skin rash (discrete and confluent erythematous macules, papules, and plaques and a few purpuric lesions on the back of trunk and upper limbs), 3 weeks after being diagnosed with coronavirus disease 2019 (COVID-19). The patient showed four out of the five features required to satisfy the working case definition of multisystem inflammatory syndrome in adults (MIS-A). Histopathology of rash was consistent with LCV. Whether, COVID-19 was the cause for LCV in our patient remains unclear. The fever, parotid enlargement and rash showed complete resolution following treatment with systemic corticosteroids and enoxaparin.

BACKGROUND Cutaneous small vessel vasculitis is a condition with various aetiologies, morphological patterns of presentation and histopathologic types. It can be primary or secondary. Cutaneous lesions being a pointer to the systemic involvement in vasculitis, it requires histology for confirmation of the diagnosis and for long-term follow up. Skin biopsy is the gold standard in diagnosis and helps in guiding further investigations and treatment. The studies regarding the various patterns and histopathological types of cutaneous small vessel vasculitis in Kerala are not well documented so far. MATERIALS AND METHODS This is a cross-sectional descriptive study done in patients with a histopathological diagnosis of cutaneous small vessel vasculitis admitted in Dermatology Ward of Government Medical College, Kozhikode, during January 2013 to January 2014. The aim of this study was to delineate the patterns, causes and to assess the clinicopathological correlation of cutaneous small vessel vasculitis. A detailed history, clinical examination of patients and 4 mm skin punch biopsy were done in all selected patients. RESULTS 66 patients diagnosed with histopathological features of cutaneous vasculitis were included in the study. Palpable purpura was the most common clinical lesion and leukocytoclastic vasculitis represented the most common histopathologic type of cutaneous small vessel vasculitis in the present study. Systemic involvement was observed in half of the patients. An aetiological association could be found in 62.2% of cases out of which drug sensitivity was the commonest cause. Out of the 66 patients, after clinicopathological correlation, 16 cases of Henoch-Schonlein purpura, 5 cases of urticarial vasculitis, 3 cases of connective tissue disease associated vasculitis (2-systemic lupus erythematosus and 1-mixed connective tissue disorder), 2 cases of ChurgStrauss vasculitis, 2 cases of nodular vasculitis, 2 cases of Behcet’s disease and 3 cases of vasculitic ulcer were identified. Rest of the 33 patients were offered a diagnosis of idiopathic cutaneous small vessel vasculitis. CONCLUSION Definitive diagnosis can be reached with skin biopsy aided with clinical features and relevant investigations including immunofluorescence. Thus, skin biopsy and clinicopathological correlation are important in the diagnosis and treatment of cutaneous small vessel vasculitis.