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Isolated Cutaneous Vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisIsolated Cutaneous VasculitisSCE Rheumatology

A 42-year-old woman presents with palpable purpura confined to both lower legs. Skin biopsy shows leucocytoclastic small-vessel vasculitis, and direct immunofluorescence shows no vascular IgA deposition. Urinalysis and renal function are normal, and she has no gastrointestinal, respiratory, neurological or constitutional features. ANCA, ANA and cryoglobulins are negative, with normal complement levels. This is classified as single-organ cutaneous small-vessel vasculitis. Which is the most commonly identified precipitating factor for this condition?

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Correct answer: E — Medication exposure

Medication exposure is the most commonly identified precipitating factor in single-organ cutaneous small-vessel vasculitis; antibiotics, NSAIDs and diuretics are recognised examples. Previous infection is another frequent trigger but is not offered here. Many cases remain idiopathic, which is why the question specifies the most common identifiable precipitant rather than the most common overall aetiological classification. Malignancy is an uncommon association. ANCA-associated vasculitis and SLE would be alternative systemic or secondary vasculitic disorders and are not supported by the clinical assessment or serology. IgA vasculitis can occasionally be skin-limited, but the absence of vascular IgA on direct immunofluorescence and the lack of renal, gastrointestinal or joint involvement make it less likely.

Reference: Loricera J et al. Single-organ cutaneous small-vessel vasculitis according to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides: results and precipitating factors. Rheumatology (Oxford), 2015. https://pubmed.ncbi.nlm.nih.gov/41399325/