Clinicopathological Features of Cutaneous Vasculitis: A Cross-sectional Study from a Tertiary Care Centre in Karnataka, India

Abstract

Introduction: Cutaneous vasculitis is an inflammatory disease of the dermal blood vessels with varying clinical presentations. It is not a single disease but a spectrum of entities that present as cutaneous vasculitis. Hence, histopathological evaluation is essential to confirm the diagnosis and determine the type of vasculitis. Direct Immunofluorescence (DIF) studies add credibility to the diagnosis. Aim: To investigate the spectrum of cutaneous vasculitis, its aetiological factors, and the clinicopathological features. Materials and Methods: This cross-sectional study was conducted over a three-year period (February 2015-January 2018). All cases of biopsy-proven cutaneous vasculitis diagnosed in the Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India were included in the study. The clinical data, along with laboratory investigations including skin biopsy and DIF, were analysed. Results: A total of 137 cases of cutaneous vasculitis were diagnosed during the study period. The age of the patients ranged from 1-73 years. The peak incidence of cutaneous vasculitis was observed in the fourth decade 31 (22.6%), with no significant gender preponderance. Palpable purpura over the lower extremities was the most common skin lesion at the time of presentation seen in 47 (34.3%). Most cases of vasculitis were primary cutaneous vasculitis, while 11 cases showed evidence of systemic vasculitis such as Wegener’s granulomatosis, Polyarteritis Nodosa (PAN), and Churg-Strauss syndrome. No underlying aetiology was identified in the majority of cases 82 (59.9%), while a possible underlying aetiology like connective tissue disorder, drug intake, infections, etc., could be identified in 55 (40.1%) cases. Small vessel vasculitis was the most frequent, with leukocytoclastic vasculitis being the predominant type seen in 89 (65%) cases. DIF positivity was sensitive, with positivity around the blood vessel wall observed in89 (87.3%) of cases (N=102). Conclusion: Vasculitis is a broad, poorly defined category of diseases and can manifest with a variety of clinical presentations. Therefore, compiling clinical, laboratory, and pathological findings is essential for formulating the diagnosis.

Keywords

• direct immunofluorescence
• inflammatory disease
• skin biopsy