New onset multiple purpuric skin lesions in an asthmatic and hypertensive pt with leukocytoclastic vasculitis noticed on biopsy. No perivascular IgA deposits are found, and no ANCA are present. Most likely diagnosis? (LQ)
|C||Macroscopic polyarteritis nodosa|
a. Leukocytoclastic angiitis refers to the histologic finding of fragmented neutrophils surrounding small blood vessels.
b. The differential diagnosis of leukocytoclastic vasculitis includes microscopic polyarteritis nodosa and three other disorders: Henoch-Schonlein purpura, Wegener’s granulomatosis, and Churg-Strauss syndrome.
c. Churg-Strauss syndrome (allergic vasculitis) is a form of necrotizing vasculitis with granulomas of the respiratory tract and asthma.
d. The disorder is associated with increased serum IgE and peripheral eosinophilia.
e. This is a strong association with allergic rhinitis, bronchial’s asthma & eosinophilia. Vessels in lung, heart, spleen, peripheral nerves & skin are frequently involved. p-ANCA are present in almost 70% of patients.