Leucocytoclastic Vasculitis — SCE Rheumatology MCQ

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EasyVasculitisLeucocytoclastic VasculitisSCE Rheumatology

A punch biopsy from a new palpable purpuric skin lesion shows inflammation and fibrinoid necrosis of dermal small-vessel walls. The infiltrate is predominantly neutrophilic, with fragmented neutrophil nuclei producing nuclear dust and associated erythrocyte extravasation. What is the histopathological pattern?

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Correct answer: D — Leucocytoclastic vasculitis

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

This is leucocytoclastic vasculitis: a neutrophilic small-vessel vasculitis characterised by fibrin or fibrinoid necrosis in vessel walls and karyorrhectic neutrophil debris (leucocytoclasia or nuclear dust), often with erythrocyte extravasation. It is a histopathological pattern rather than a specific aetiological diagnosis; the clinical context and direct immunofluorescence may identify IgA vasculitis, ANCA-associated disease, cryoglobulinaemia, a drug or infection trigger, or skin-limited disease. Granulomatous patterns (A and B) require granulomatous inflammation; giant-cell arteritis additionally affects arteries rather than dermal postcapillary venules. Lymphocytic vasculitis (D) is lymphocyte-predominant. Thrombotic vasculopathy (C) produces vascular occlusion without primary inflammatory destruction of the vessel wall.

Reference: Fraticelli P, Benfaremo D, Gabrielli A. Diagnosis and management of leukocytoclastic vasculitis. Internal and Emergency Medicine. 2021;16:831–841. https://pubmed.ncbi.nlm.nih.gov/33713282/