Nasseri Mana, Jia Justin L, Croffoot James
Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Department of Dermatology, George Washington University, Washington, D.C., USA.
Cureus. 2025 Apr 11;17(4):e82105. doi: 10.7759/cureus.82105. eCollection 2025 Apr.
Leukocytoclastic vasculitis (LCV) is an immune-mediated small-vessel vasculitis with various underlying causes. We present a unique case of LCV in an elderly man with Fitzpatrick phototype V skin to highlight multi-organ signs associated with this rare pathology. Our patient presented with an evolving, diffusely spread rash following respiratory symptoms accompanied by muscle weakness, scant hemoptysis, and decreased visual acuity. A comprehensive diagnostic approach, including skin biopsy, revealed LCV with associated eosinophilia. Treatment through a multidisciplinary approach included systemic steroids, topical ointments, and empiric antibiotics. The patient showed gradual improvement and was discharged after nine days of hospitalization. Differential diagnoses for the rash included infections, inflammatory processes, and autoimmune vasculitides such as immunoglobulin A (IgA) vasculitis, urticarial vasculitis, cryoglobulinemic vasculitis, and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides. While most instances of LCV are typically skin-limited and self-resolving, this case highlights diffuse systemic involvement requiring a broad diagnostic perspective.
白细胞破碎性血管炎（LCV）是一种由免疫介导的小血管炎，有多种潜在病因。我们报告了一例罕见的老年男性白细胞破碎性血管炎病例，该患者为 Fitzpatrick V 型皮肤，以突出与这种罕见病理相关的多器官体征。我们的患者在出现呼吸道症状后，出现了不断发展、广泛扩散的皮疹，并伴有肌肉无力、少量咯血和视力下降。包括皮肤活检在内的综合诊断方法显示为伴有嗜酸性粒细胞增多的白细胞破碎性血管炎。通过多学科方法进行的治疗包括全身用类固醇、外用软膏和经验性抗生素。患者病情逐渐好转，住院九天后出院。皮疹的鉴别诊断包括感染、炎症过程以及自身免疫性血管炎，如免疫球蛋白 A（IgA）血管炎、荨麻疹性血管炎、冷球蛋白血症性血管炎和抗中性粒细胞胞浆抗体（ANCA）相关血管炎。虽然大多数白细胞破碎性血管炎病例通常局限于皮肤且可自行缓解，但该病例突出了需要广泛诊断视角的弥漫性全身受累情况。
