Sakkab Ramez, Fabrikant Jerry M
Podiatric Surgery, Scripps Mercy Hospital, San Diego, USA.
Podiatric Surgery, Sharp Grossmont Hospital, La Mesa, USA.
Cureus. 2022 May 26;14(5):e25371. doi: 10.7759/cureus.25371. eCollection 2022 May.
The estimated incidence of leukocytoclastic vasculitis of any etiology is between 15 and 30 people per million per year. Despite being a rare pathologic entity, leukocytoclastic vasculitis has many documented etiologies. Here, we report on a case of a 47-year-old man with liver cirrhosis who was admitted to our institution for diffuse palpable purpura of the distal lower extremities. Workup was largely negative for infectious and systemic causes. The patient received multiple days of intravenous antibiotics and consultations with infectious disease, dermatology, and podiatry. Skin biopsies confirmed a diagnosis of idiopathic leukocytoclastic vasculitis. A steroid taper was prescribed, and the patient had clinical resolution and healing of skin lesions. After 5.5 years after the vasculitic episode, the patient remained free of cutaneous lower extremity lesions. Medication-induced leukocytoclastic vasculitis and associations with systemic illness or malignancy were ruled out. In the lower extremities, misdiagnosis of cellulitis for noninfectious dermatologic conditions is common. Clinicians must have a wide differential and take a multidisciplinary approach to similar types of cases to reduce unnecessary antibiotic usage.
任何病因的白细胞破碎性血管炎的估计发病率为每年每百万人中有15至30人。尽管白细胞破碎性血管炎是一种罕见的病理实体，但有许多已记录的病因。在此，我们报告一例47岁肝硬化男性患者，因双下肢远端弥漫性可触及紫癜入住我院。检查结果在很大程度上排除了感染性和全身性病因。患者接受了多日静脉抗生素治疗，并咨询了传染病科、皮肤科和足病科。皮肤活检确诊为特发性白细胞破碎性血管炎。给予逐渐减量的类固醇治疗，患者临床症状缓解，皮肤病变愈合。血管炎发作5.5年后，患者双下肢皮肤病变未再出现。排除了药物性白细胞破碎性血管炎以及与全身性疾病或恶性肿瘤的关联。在下肢，蜂窝织炎误诊为非感染性皮肤病的情况很常见。临床医生必须有广泛的鉴别诊断思路，并采取多学科方法处理类似病例，以减少不必要的抗生素使用。
