Case study: cutaneous leukocytoclasis vasculitis

A 69-year-old man was admitted to a medical ward with the diagnosis of left leg cellulitis on flucloxacillin. On further questioning, he noticed a rash with blisters on his lower legs two weeks prior to the admission.

Systemic review was unremarkable. Blood results showed:

• • White cell count 11.15 10*9/L (n 4-11)
  • Serum CRP 74
  • Renal function tests were normal
  • Serum Anti ENA Screen negative
  • Anti Myeloperoxidase Antibodies 0.3 IU/mL (n 0-3.4)
  • Anti Proteinase 3 0.6 IU/mL (n 0 – 1.9)
  • Cyclic citrullinated peptide 3U/mL (n 0-7)
  • Hepatitis Bs antigen not detected
  • Hepatitis C IgG antibody not detected
  • Serum C3 1.55g/L (n 0.90 – 1.80)
  • Serum C4 0.25g/L(n 0.10 – 0.40)
  • Anti-Nuclear Antibody positive
  • Anti DNA Antibodies 4.0 (n -10)

Skin punch biopsy findings were consistent with leukocytoclasis vasculitis. The rash was treated with clobetasol propionate ointment twice daily.

Leukocytoclasis vasculitis is a small vessel vasculitis. Cutaneous leukocytoclasis vasculitis (CLCV) is usually confined to skin with rare extracutaneous manifestations.

The presenting features of CLCV include purpuric rash affecting lower extremities and small vessel involvement.^1,2,3

The incidence of biopsy proven CLCV is approximately 45/million individuals/year. If CLCV is suspected, a skin punch biopsy should be performed. Most cases are self-limited with 90% resolving in weeks to months of onset. In persistent vasculitis, treatment depends on the severity of disease and can range from oral corticosteroids to steroid-sparing agents.

Authors

Khalesi D Sebastian FY2, Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex

Kelum V Ruwanpura, Speciality Registrar, Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex

Muhammad JH Rahmani,  Consultant Physician,  Department of Health and Aging, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, East Sussex

References

1. Piubelli MLM, Felipe-Silva A, Kanegae MY, Ferraz de Campos FP. Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis. Autops Case Rep. 2019 Apr-Jun;9(2): e2018070. [PMC free article] [PubMed]
2. Younger DS, Carlson A. Dermatologic Aspects of Systemic Vasculitis. Neurol Clin. 2019 May;37(2):465-473. [PubMed]
3. Alquorain NAA, Aljabr ASH, Alghamdi NJ. Cutaneous Polyarteritis Nodosa Treated with Pentoxifylline and Clobetasol Propionate: A Case Report. Saudi J Med Med Sci. 2018 May-Aug;6(2):104-107. [PMC free article] [PubMed]

Rahmani MJH

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