Demographic, etiological and clinical characteristics of patients with leukocytoclastic vasculitis single center experience

Abstract

Abstract

Background/Aims:

Methods:

Results:

Conclusions: 

ABSTRACT

Background/Aims:
Leukocytoclastic vasculitis is a small vessel vasculitis form which primarily affects the post capillary venules with primary skin involvement. Various causes such as drugs, infections, malignancies, systemic inflammatory diseases are included in etiology. However, some of the cases cannot be detected and these cases are evaluated as idiopathic.Clinically, it is characterized by limited palpable purpura at the lower extremities, and rarely a widespread involvement. In this study, we aimed to determine the etiologic factors, demographic and clinical characteristics of patients with leukocytoclastic vasculitis in our clinic.

Material and Methods: Forty patients with leukocytoclastic vasculitis were included in the study between January 2018 and April 2019 according to the 2012 International Chapel Hill Meeting in the Department of Rheumatology. Epidemiological, clinical, laboratory findings and treatment information of the patients were obtained by examining the file records.

Results:
Forty patients (25 females, 15 males) were found to have a median age of 48.02 ± 19.9. Although no etiologic factor was found in 37,5% of the patients, 25% of the remaining patients had a history of infection and / or drug use, 37.5% of the patients were accompanied by malignancy and rheumatic disease Systemic corticosteroids were the most commonly used treatment options.

Conclusion: Leukocytoclastic vasculitis is a well-functioning, self-limiting disease that can be accompanied by drugs and infection, malignancy and rheumatologic diseases. Defining the etiologic cause is an important step to therapy, while systemic corticosteroid are an effective therapeutic choice

Keywords

• Leukocytoclastic vasculitis,etiology

Lökositoklastik vaskülitli hastaların demografik, etyolojik ve klinik özellikleri tek merkez deneyimi

Abstract

ÖZ

Amaç: Lökositoklastik vaskülit, primer deri tutulumu ile seyreden, esas olarak post kapiller venülleri etkileyen bir küçük damar vaskülit formudur. Etiyolojide ilaçlar, enfeksiyonlar, maligniteler, sistemik inflamatuvar hastalıklar gibi çeşitli nedenler yer almaktadır. Ancak olguların bir kısmında neden saptanamamakta ve bu olgular idiyopatik olarak değerlendirilmektedir. Klinik olarak özellikle alt ekstremitelerde sınırlı palpe edilebilen purpuralar ile karakterize olup, nadiren yaygın tutulum da gözlenebilmektedir. Bu çalışmada, kliniğimizde lökositoklastik vaskülit tanısı almış hastalarda etiyolojik faktörler, demografik ve klinik özelliklerin belirlenmesi amaçlanmıştır.

 Gereç ve Yöntemler: Çalışmaya Ocak 2018 - Nisan  2019 arasında Romatoloji Bilim Dalında 2012 Uluslararası Chapel Hill Toplantısına göre lökositoklastik vaskülit  tanısı konulan  40 hasta dahil edildi. Çalışmaya 18 yaş üstü hastalar dahil edildi. Hastaların epidemiyolojik, klinik, laboratuar bulguları ve tedavi bilgileri retrospektif olarak dosya kayıtları incelenerek elde edildi.

Bulgular: Kırk hastanın (25 kadın, 15 erkek) yaş ortalaması 48.02±19.9 olduğu tespit edildi. Kutanöz lezyonlar en sık alt ekstremite yerleşimli, palpe edilebilen purpurik papül-plaklar şeklindeydi ve lezyonlara en sık eşlik eden semptomun kaşıntı olduğu saptandı. Hastaların %37.5 ’inde herhangi bir etyolojik neden saptanmamasına karşın, kalan hastaların %25’inde enfeksiyon ve/veya ilaç kullanımı öyküsü mevcuttu. Hastaların % 37.5’ine malignite ve romatizmal hastalık eşlik ediyordu. Sistemik kortikosteroidler en sık tercih edilen tedavi seçeneğiydi.

Sonuç: Lökositoklastik vaskülit çoğunlukla ilaçlar ve enfeksiyon tarafından tetiklenen, malignite ve romatolojik hastalıkların da eşlik edebileceği iyi seyirli, kendi kendini sınırlayan bir hastalıktır. Altta yatan etiyolojinin belirlenmesi tedavide önemli bir basamak olmakla birlikte sistemik kortikosteroidler de etkin bir tedavi seçeneğidir.

Keywords

• Lökositoklastik vaskülit,etyoloji

References

1. 1:Goeser MR, Laniosz V, Wetter DAJAjocd. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. 2014;15(4):299-306.
2. 2. Jennette JC, Falk R, Bacon P, Basu N, Cid M, Ferrario F, et al. 2012 revised international chapel hill consensus conference nomenclature of vasculitides. 2013;65(1):1-11.
3. 3. Loricera J, Blanco R, Ortiz-Sanjuán F, Hernández JL, Pina T, González-Vela MC, et al. Single-organ cutaneous small-vessel vasculitis according to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides: a study of 60 patients from a series of 766 cutaneous vasculitis cases. 2014;54(1):77-82.
4. 4. Stone JH, Nousari HCJCoir. “Essential” cutaneous vasculitis: what every rheumatologist should know about vasculitis of the skin. 2001;13(1):23-34.
5. 5. Gambichler T, Kulik MA, Skrygan M, Rooms I, Höxtermann SJAiD, Alergologii APDi. Cutaneous leukocytoclastic vasculitis: the role of lymphocytes and related immune markers. 2017;34(4):299.
6. 6. Cakiter AU, Kucuk OS, Ozkaya DB, Topukcu B, Onsun NJAiD, Alergologii APDi. Demographic characteristics, aetiology, and assessment of treatment options in leukocytoclastic vasculitis. 2017;34(2):104.
7. 7. Haehn DA, Patel A, Youngberg G, Gonzalez-Estrada AJBcr. Ceftriaxone-induced leucocytoclastic vasculitis. 2019;12(4)
8. 8. Li X, Xia J, Padma M, Ma Z, Tian YJJocp. Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with HIV. 2019.

9. 9. Martínez MJM, Sánchez DP, Martínez EP, Martínez AH, González MMJRC. Leukocytoclastic Vasculitis and Infection. Report of a Case. 2017;13(5):297-8.
10. 10. Bouiller K, Audia S, Devilliers H, Collet E, Aubriot MH, Leguy-Seguin V, et al. Etiologies and prognostic factors of leukocytoclastic vasculitis with skin involvement: a retrospective study in 112 patients. 2016;95(28).
11. 11. Khetan P, Sethuraman G, Khaitan BK, Sharma VK, Gupta R, Dinda AK, et al. An aetiological & clinicopathological study on cutaneous vasculitis. The Indian journal of medical research. 2012;135:107-13.
12. 12. Pastuszczak M, Celińska-Löwenhoff M, Sułowicz J, Wojas-Pelc A, Musiał JJM. Clinical study on single-organ cutaneous small vessels vasculitis (SoCSVV). 2017;96(12).
13. 13. Sahin EB, Hapa A, Elçin G, Karaduman A, Evans SE, Erkin G, et al. Lökositoklastik Vaskülit: 60 Hastanin Geriye Dönük Analizi/Leukocytoclastic Vasculitis: Retrospective Analysis of 60 Patients. 2011;5(4):85.
14. 14. Brown K, Martin J, Zito SJJomcr. Severe leukocytoclastic vasculitis secondary to the use of a naproxen and requiring amputation: a case report. 2010;4(1):204.
15. 15. Doyle MK, Cuellar MLJEoods. Drug-induced vasculitis. 2003;2(4):401-9.
16. 16. Solans-Laque R, Bosch-Gil JA, Pérez-Bocanegra C, Selva-O'Callaghan A, Simeón-Aznar CP, Vilardell-Tarres MJTJor. Paraneoplastic vasculitis in patients with solid tumors: report of 15 cases. 2008;35(2):294-304.
17. 17. Fain O, Hamidou M, Cacoub P, Godeau B, Wechsler B, ParIès J, et al. Vasculitides associated with malignancies: analysis of sixty patients. 2007;57(8):1473-80.
18. 18. González-Gay MA, Garcia-Porrua C, Salvarani C, Hunder GJC, rheumatology e. Cutaneous vasculitis and cancer: a clinical approach. 2000;18(3):305-8.
19. 19. Wooten MD, Jasin HE, editors. Vasculitis and lymph op roliferative diseases. Seminars in arthritis and rheumatism; 1996: Elsevier.
20. 20. Loricera J, Calvo-Río V, Ortiz-Sanjuán F, González-López MA, Fernández-Llaca H, Rueda-Gotor J, et al. The spectrum of paraneoplastic cutaneous vasculitis in a defined population: incidence and clinical features. 2013;92(6):331.
21. 21. Greer JM, Longley S, Edwards NL, Elfenbein GJ, Panush RSJM. Vasculitis associated with malignancy. Experience with 13 patients and literature review. 1988;67(4):220-30.
22. 22. Tai YJ, Chong AH, Williams RA, Cumming S, Kelly RIJAjod. Retrospective analysis of adult patients with cutaneous leukocytoclastic vasculitis. 2006;47(2):92-6.
23. 23. Martinez-Taboada VM, Blanco R, Miguel Garcia-Fuentes M, Vicente Rodriguez-Valverde MJTAjom. Clinical features and outcome of 95 patients with hypersensitivity vasculitis. 1997;102(2):186-91.
24. 24. Gyselbrecht L, De FK, Ongenae K, Naeyaert J, Praet M, Veys EJC, et al. Etiological factors and underlying conditions in patients with leucocytoclastic vasculitis. 1996;14(6):665-8.
25. 25. Jessop SJR. Cutaneous leucocytoclastic vasculitis: a clinical and aetiological study. 1995;34(10):942-5.
26. 26. Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes MJM. Cutaneous vasculitis in children and adults. Associated diseases and etiologic factors in 303 patients. 1998;77(6):403-18.
27. 27. af Ekenstam E, Callen JPJAod. Cutaneous leukocytoclastic vasculitis: clinical and laboratory features of 82 patients seen in private practice. 1984;120(4):484-9.
28. 28. Sais G, Vidaller A, Jucgla A, Servitje O, Condom E, Peyrí JJAoD. Prognostic factors in leukocytoclastic vasculitis: a clinicopathologic study of 160 patients. 1998;134(3):309-15.
29. 29. Bouiller K, Audia S, Devilliers H, Collet E, Aubriot MH, Leguy-Seguin V, et al. Etiologies and prognostic factors of leukocytoclastic vasculitis with skin involvement: A retrospective study in 112 patients. Medicine. 2016;95(28):e4238.
30. 30. El-Reshaid K, Madda JPJCrid. Rituximab therapy for severe cutaneous leukocytoclastic angiitis refractory to corticosteroids, cellcept and cyclophosphamide. 2013;5(1):115-9.
31. 31. ERTURAN İ, CEYHAN AM, MERİÇ G, KAZANOĞLU OO, AKKAYA VB, BAŞAK PY, et al. Kutanöz Küçük Damar Vaskülitli 50 Olgunun Retrospektif Analizi. 2013;23(2):39-45.