Case Number : Case 687 - 1 Feb Posted By: Guest

LCV

Leukocytoclastic vasculitis.

LCV

LCV, but is it quite deep? and lots of extravasd rbcs especially in papillary dermis? LCV related to CTD? cryoglobulins? Parvo? HSP?

Livedoid vasculitis

Fully developed leukocytoclastic vasculitis of both superficial and deep plexuses.

I did not diagnose LCV in this case. Neutrophils and sparse eosinophils
were present but the infiltrate is mainly lymphocytic. I deliberately
photographed the most "inflammatory" areas. She had a long history of recurrent
crops of lesions that also involved the dorsa of the feet.

As the infiltrate was mainly lymphocytic, and these represent most inflammatory areas which means that some areas are non or less inflammatory and with clinical correlation, I will revise my diagnosis to atrophie blanche, lividoid vasculitis.

PLEVA? febrile ulceronecrotic MH disease? or thrombocclusive? maybe APLS?

Lividoid vasculitis.

[font="Palatino Linotype, serif"][size="3"]Further information gave me a chance for revising my opinion. Gender, affected regions, and a history of chronic course with spontaneous remissions and exacerbations favor livedoid vasculitis, as well as the microscopic features of mild lymphocytic vasculitis with fibrin deposition in the vessel wall. Nevertheless, this disese is expected in older patients and there's no notice about white atrophic plaques of healed lesions.[/size][/font]
[font="Palatino Linotype, serif"][size="3"]Collagen tissue disease vasculitis may be an alternative hypothesis since some neutrophils and nuclear dust can be found.[/size][/font]

I would add levamisole-induced necrosis to the differential.

Many thanks all. In fact we did think there might be an assocition with the
oral contraceptive pill in this case. We diagnosed livedoid vasculopathy based
on clinicopathological correlation. There were very nice PAS positive fibrin
rings. It just shows you that as in the previous case (thrombrophlebitis) you
can get prominent inflammatory infiltrates in the response / healing phase
of coagulopathies and thrombotic disorders.