Lökositoklastik vaskülitli hastaların klinik ve patolojik özelliklerinin değerlendirilmesi: tek merkez romatoloji deneyimi

Abstract

Amaç: Bu çalışmada lökositoklastik vaskülitli (LCV) yetişkin hastaların klinik ve patolojik özelliklerinin incelenmesi ve romatoloji pratiğinde direkt immünofloresan (DIF) testin tanısal katkısının değerlendirilmesi amaçlandı. Yöntem: Çalışmaya Haziran 2020 ile Nisan 2025 arasında palpabl purpura ile romatoloji kliniğine başvuran, deri biyopsisi ile LCV tanısı almış ve DIF testi yapılmış 102 yetişkin hasta dahil edildi. Hastaların klinik ve histopatolojik özellikleri retrospektif olarak incelendi. Bulgular: Tüm tanı testlerinden sonra 84 hasta (%82,4) immünoglobulin A vasküliti (IgAV) ve 11 hasta (%10,8) tek organ kutanöz küçük damar vasküliti (SoCSVV) olarak sınıflandırılmıştı. Altmış beş hastada (%63,7) komorbid hastalık vardı; endokrin-metabolik (%36,3) ve kardiyovasküler hastalıklar (%30,4) en yaygın komorbiditelerdi. Seksen dört hasta (%82,3) çeşitli dozlarda kortikosteroid almıştı ve 41 hastaya (%40,1) steroid ayırıcı tedavi verilmişti. DIF testi 55 hastada (%54) nihai klinik tanıyı desteklerken, 20 hastada (%19,6) nonspesifik bulgular gösterdi ve 27 hastada (%26.4) negatif idi. DIF sonuçları yalnızca 14 hastada (%13,7) klinik ön tanıda değişikliğe yol açmıştı. Deriye sınırlı sistemik vaskülitli hastalar ile SoCSVV'li hastaların başvurudaki laboratuvar ve klinik bulguları karşılaştırıldığında iki grup arasında anlamlı bir fark saptanmadı. Sonuç: Erişkin romatoloji kliniklerinde değerlendirilen lökositoklastik vaskülitlerin, özellikle IgAV olmak üzere sistemik vaskülitlerin bir komponenti olma olasılığı yüksektir. LCV'li yetişkinlerin çoğu komorbiditelere sahiptir ve kortikosteroidlere ihtiyaç duyar. Klinik uygulamada, DIF testinin LCV'li hastaları sınıflandırmadaki etkisi sınırlıdır.

Keywords

• Lökositoklastik Vaskülit
• İmmünglobulin A Vasküliti
• İmmünofloresan
• Patoloji

Clinical and pathological evaluation of patients with leukocytoclastic vasculitis: a retrospective single-center rheumatology experience

Abstract

Aims: This study aimed to evaluate the clinical and pathological characteristics of adult patients with leukocytoclastic vasculitis (LCV) and to assess the diagnostic impact of direct immunofluorescence (DIF) test in rheumatology practice. Methods: The study included 102 adult patients admitted to the rheumatology clinic with palpable purpura between June 2020 and April 2025. All of the patients have a DIF test and a positive skin biopsy for LCV. The clinical and histopathological characteristics of the patients were retrospectively reviewed. Results: After all diagnostic tests, 84 patients (82.4%) were classified as immunoglobulin A vasculitis (IgAV) and 11 (10.8%) as single-organ cutaneous small vessel vasculitis (SoCSVV). Sixty-five patients (63.7%) had comorbid diseases; endocrine-metabolic (36.3%) and cardiovascular diseases (30.4%) were the most common. Eighty-four patients (82.3%) received corticosteroids at various doses, and 41 (40.1%) received steroid-sparing agent. The DIF test supported the final clinical diagnosis in 55 patients (54%), was negative in 27 patients (26.4%), and revealed non-specific findings in 20 patients (19.6%). DIF results led to a change in the clinical pre-diagnosis in only 14 patients (13.7%). No significant differences were found between the two groups when comparing the laboratory and clinical findings at presentation in patients with skin-limited systemic vasculitis and those with SoCSVV. Conclusion: Leukocytoclastic vasculitides that are assessed in adult rheumatology clinics are highly likely to be part of systemic vasculitides, particularly IgAV. Most adults with LCV have comorbidities and need corticosteroids. In clinical practice, the impact of the DIF test on classifying patients with LCV is limited.

Keywords

• Leukocytoclastic vasculitis
• immunofluorescence
• immunoglobulin A vasculitis
• pathology

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