Leukocytoclastic Vasculitis — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisLeukocytoclastic VasculitisSCE Dermatology

A 50-year-old man with leukocytoclastic vasculitis has palpable purpura on his lower legs. Biopsy confirms small-vessel vasculitis with fibrinoid necrosis. The vasculitis is idiopathic. What is the recommended initial workup?

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Reveal the answer and explanation

Correct answer: A — FBC, ESR/CRP, urinalysis, renal function, LFTs, immunoglobulins, complement, ANCA, hepatitis B/C serology, cryoglobulins, and ANA

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

Option A (FBC, ESR/CRP, urinalysis, renal function, LFTs, immunoglobulins, complement, ANCA, hepatitis B/C serology, cryoglobulins, and ANA) is correct. Even when leukocytoclastic vasculitis appears clinically idiopathic, a systematic screen is required because histology alone cannot distinguish primary cutaneous small-vessel vasculitis from a cutaneous manifestation of systemic vasculitis, connective tissue disease, paraproteinaemia, infection (notably hepatitis B/C) or malignancy. Urinalysis and renal function are essential first-line tests because renal involvement is often asymptomatic yet dictates whether immunosuppression and specialist referral are needed. ANCA, ANA, complement and cryoglobulins screen for the major secondary causes (ANCA-associated vasculitis, SLE, cryoglobulinaemic vasculitis), while immunoglobulins help identify IgA vasculitis or paraproteinaemia, and LFTs plus hepatitis serology screen for viral-associated vasculitis. This comprehensive baseline panel reflects standard UK dermatology practice for newly diagnosed cutaneous vasculitis before it can genuinely be labelled idiopathic.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions