Kuniyuki S, Katoh H
Division of Dermatology, Osaka City Juso Municipal Hospital, Japan.
J Dermatol. 1996 Apr;23(4):279-83. doi: 10.1111/j.1346-8138.1996.tb04013.x.
We describe a case of urticarial vasculitis accompanied by erythematous wheals, palpable pupura, and subsequent necrotic ulcerated papular lesions in a patient with type C chronic hepatitis and type II cryoglobulinemia (IgM-kappa and polyclonal IgG). A 56-year-old man developed recurrent urticarial lesions on his lower extremities and trunk. The histology revealed leukocytoclastic vasculitis with perivascular immunoglobulin deposits. Subsequently, multiple reddish papular lesions with necrotic ulcerations appeared on the extensor aspect of his extremities and buttocks. Histology of these lesions showed cryoglobulinemic vasculitis with prominent fibrinoid necrosis of the vascular walls and cryoprecipitate within the vasculature as well as increased hyalinized collagen bundles. These papular lesions have not previously been described as cutaneous necrotizing venulitis to the best of our knowledge. It is suggested that the immune response to hepatitis C virus infection and cryoglobulins may be responsible for severe necrotizing venulitis, resulting in unusual cutaneous lesions.
我们报告一例患有丙型慢性肝炎和II型冷球蛋白血症（IgM-κ和多克隆IgG）的患者，其出现伴有红斑性风团、可触及的紫癜及随后坏死性溃疡丘疹性病变的荨麻疹性血管炎。一名56岁男性患者下肢和躯干出现反复发作的荨麻疹性皮损。组织学检查显示白细胞破碎性血管炎伴血管周围免疫球蛋白沉积。随后，其四肢伸侧和臀部出现多个伴有坏死性溃疡的红色丘疹性病变。这些病变的组织学检查显示冷球蛋白血症性血管炎，血管壁有显著的纤维蛋白样坏死，血管内有冷沉淀物，同时透明化胶原束增加。据我们所知，这些丘疹性病变此前尚未被描述为皮肤坏死性静脉炎。提示对丙型肝炎病毒感染和冷球蛋白的免疫反应可能是严重坏死性静脉炎的原因，导致出现不寻常的皮肤病变。
