Cutaneous vasculitis

Vasculitis is defined as inflammation of blood vessels and can affect multiple organs. Several classification systems exist to categorize vasculitis such as vessel size, presence of anti-neutrophil cytoplasmic antibody, pathogenesis of the inflammation, and type of inflammatory cell infiltrate. Cutaneous vasculitis occurs as a manifestation of many diseases including rheumatologic diseases, hypersensitivity syndromes, infections, and malignancies. The diagnosis of the cutaneous vasculitis and the underlying cause requires a complete history and physical exam and usually a biopsy or angiogram. The treatment depends on the etiology of the inflammation and includes immunosuppression, withdrawal of the offending agent, antibacterial/antiviral agents, and chemotherapies. A clear understanding and approach to this condition will improve the physician’s ability to provide optimal patient care.     

Cutaneous vasculitis associated with fluoroquinolones

Cutaneous vasculitis is a clinical entity with a broad differential diagnosis, including an adverse drug reaction. It is defined as inflammation of skin blood vessel walls. During a 7-year-period, we observed three patients who developed isolated cutaneous vasculitis during antibiotic therapy of bacterial infection. All were treated with a fluoroquinolone (ciprofloxacin or levofloxacin) combined with rifampin (two cases) or flucloxacillin (three cases), respectively. In all three cases the lesions gradually resolved after treatment with the inciting fluoroquinolone had been stopped. In one patient, leukocytoclastic small-vessel vasculitis was histologically confirmed. Fluoroquinolone-associated cutaneous vasculitis consists of an isolated self-limiting disorder that is part of a systemic vasculitis, or even life-threatening disease. Clinicians should be aware of this serious adverse event because any continuation of treatment may be fatal.     

Cutaneous vasculitis associated with pheochromocytoma

We describe a patient who presented with constitutional symptoms, severe hypertension, and purpuric lesions over the knees, thighs, and penis. The patient was eventually diagnosed as having multiple endocrine neoplasia type II, with cutaneous leukocytoclastic vasculitis. The cutaneous vasculitis persisted despite treatment with high-dose systemic corticosteroids, but rapidly resolved after the removal of bilateral pheochromocytomas. This case demonstrates cutaneous leukocytoclastic vasculitis in association with pheochromocytoma.     

Cutaneous vasculitis associated with rofecoxib

SIR, We read with interest the recent letter concerning a celecoxib-inducedcutaneous vasculitis [1]. There are no such case reports concerningrofecoxib. There have now been several case reports recentlydocumenting cutaneous vasculitis in association with the cyclooxygenase2 (COX-2)-specific non-steroidal anti-inflammatory drug (NSAID)celecoxib [1–3]. One case of fatal allergic vasculitis,described in Lancet [2     

Cutaneous vasculitis disclosing pulmonary tuberculosis

We report the case of a patient with leukocytoclasic vasculitis that disclosed active pulmonary tuberculosis. This patient had no signs of systemic vasculitis. The clinical course was favorable with anti-tuberculosis drugs alone. There has been no recurrence at 8 months.Vasculitis associated with tuberculosis is uncommon. The pathophysiological mechanism remains uncertain. No immunosuppressor treatment is needed and the vasculitis generally regresses with treatment of the infection.     

Cutaneous vasculitis associated with rifampin therapy

Immune complex-mediated vasculitis is a well-recognized form of idiosyncratic drug reaction. We report cutaneous vasculitis in association with therapy with rifampin (rifampicin). To our knowledge, this has not previously been documented. Rifampin is widely used, and such reactions are therefore important to note.     

Cutaneous vasculitis complicating coeliac disease.

A 38 year old female, with chronic uncontrolled coeliac disease, presented with the rare complication of cutaneous leucocytoclastic vasculitis. Detailed study failed to identify any cause for the vasculitis, other than the underlying coeliac disease. Haematuria and proteinuria with mesangial nephritis were also demonstrated on renal biopsy with electron microscopic study. It is speculated that exogenous or endogenous antigens permeated the abnormal small bowel mucosa leading to formation of circulating immune complexes. Subsequent tissue deposition of these complexes then resulted in vasculitis and nephritis. The skin lesions cleared completely after treatment with a strict gluten free diet.     

Cutaneous vasculitis in adult polymyositis/dermatomyositis

Seven (9.2%) of 76 patients with adult-onset polymyositis/dermatomyositis (PM/DM) seen over an 11-year period had cutaneous vasculitis. This was manifest by dermal and/or subcutaneous nodules in 4, periungual infarcts in 3 and digital ulceration in 2. When these 7 patients were compared to the remaining 69, a significant association was noted between cutaneous vasculitis and DM (p = .025); only 1 of 31 patients with primary PM and none of 18 with overlap syndromes had vasculitis. Furthermore, 2 (28.6%) of those with vasculitis had an associated malignancy compared to only 4 (5.8%) of those without vasculitis. These data document the occurrence of cutaneous vasculitis in adult-onset PM/DM and suggest that its presence may be a marker of an underlying malignancy.     

Cutaneous vasculitis, hypersensitivity vasculitis, erythema nodosum, and pyoderma gangrenosum

Cutaneous vasculitis encompasses a highly heterogeneous group of disorders of diverse etiology, pathogenesis, and clinical features. Recent reexamination of clinical pathologic features have yielded no insights assisting our understanding of current clinical classification schemes and strengthening our clinical approach. Erythema nodosum is a common cutaneous disorder for which new etiologies continue to be described. Pyoderma gangrenosum is an uncommon ulcerative cutaneous condition that remains a therapeutic problem.     

Cutaneous vasculitis associated with tuberculosis and its treatment

Two patients with pulmonary tuberculosis developed cutaneous vasculitis after antituberculosis treatment and a patient with tuberculous lymphadenitis developed vasculitis at presentation before drug therapy. The cutaneous vasculitis probably represented immunological reactions to tubercle bacilli and/or rifampicin with antibodies and immune complex formation.