Clinical, Histo-Pathological And Immunofluorescence Study Of Cutaneous Vasculitis: In A Tertiary Care Hospital

Abstract

Background: Cutaneous vasculitis represents a group of disorders characterized by inflammation of blood vessel wall and it may involve any organ system. Skin biopsy is considered gold standard for the diagnosis and direct immunofluorescence (DIF) aids in categorization. There are very few studies from India which correlate clinical, histopathological as well as DIF findings in patients with cutaneous small vessel vasculitis (CSVV).

Objectives: Objective of this study was to determine the epidemiology of cutaneous vasculitis and its aetiological association, and to study the diagnostic value of histopathological examination and DIF in patients with cutaneous vasculitis.

Materials and method: It was a hospital based cross-sectional study. Fifty consecutive patients attending the Dermatology outpatient department clinically diagnosed as cutaneous vasculitis were included and relevant history was taken. Complete hemogram, urine microscopy and two skin biopsy specimens for histopathology and DIF were taken from all patients. Clinical, histopathological and immunofluorescence findings were analyzed.

Results: Out of 50 patients, 35 (70%) were male and 15 (30%) were females. Males outnumbered females in the ratio of 2.3:1. Adolescents and adults were the common sufferers (n= 44, 88%). Upper respiratory tract infection (n=9, 18%) was the commonest precipitating factor followed by NSAID (n=9,18%). Palpable purpura was the commonest cutaneous manifestation (n=46, 92%) and extracutaneous involvement was noted in 33 (66%) patients i.e., joint pain, abdominal pain and hematuria. Joint x pain was the commonest systemic complaint (n= 35, 70%). On histopathology, the commonest pattern seen was leukocytoclasia and extravasation of Red blood cells (RBC). DIF showed overall positivity 98 % (49) , (n=30, 60%) with IgA , (n=44, 88%) with C3. The importance of IgA deposits in the vessel wall in the diagnosis of cutaneous vasculitis is controversial. In our study, the overall sensitivity of IgA for HSP in children and adults is 83.3% and 65% respectively. Therefore IgA is not very sensitive in adults for HSP. Conclusion: Direct immunoflourescence in cutaneous vasculitis is a useful ancillary tool provided there is optimal clinicopathological diaganosis. Though IgA positivity does not confirm the diagnosis of HSP, but it can be a supportive finding.