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Vascular Diseases: Various forms of Vasculitis 

Dr Sampurna Roy MD          

 

                                                                                                                      

 

 

High power view of a blood vessel in a case Leukocytoclastic Vasculitis

The six major groups of vascular diseases are as follows:

1) Non Inflammatory Purpura:

Example: Senile Purpura

2) Vascular-occlusive Diseases:

Example:

Disseminated Intravascular Coagulation ;

Atrophie blanche ; Dermatopathology Case 74

Cryoglobulinemia ;

Thrombotic thrombocytopenic purpura ; 

Thrombocythemia.

3) Urticaria:

4) Acute Vasculitis:  Example: Leukocytoclastic Vasculitis : Dermatopathology Case 123

5) Neutrophilic Dermatosis:

Example:  

Sweet's Syndrome ; Dermatopathology Case 40

Rheumatoid neutrophilic dermatosis ; (Rheumatoid Nodule)

Behcet's disease. 

6) Miscellaneous:

Vasculitis is a group of disorders in which there is inflammation and damage of blood vessel walls.

The lesion may be limited to the skin or some other organ or may be a mutisystem disorder.

Classification of vasculitis based on pathogenesis:

 

Direct Infection:

Bacterial ; Rickettsial;  Mycobacterial;  Spirochetal ; Fungal -Mycoses (Example: Mucormycosis); Viral (Example: Herpes)

 

Immunological injury:

Immune Complex Mediated:  

- Henoch-Schonlein purpura ;

- Cryoglobulinemic vasculitis ;

- Drug induced vasculitis;

- Lupus vasculitis; 

- Rheumatoid vasculitis ;

- Serum Sickness vasculitis;

- Infection; Induced immune complex vasculitis ; (i) Viral (Example. Hepatitis B and C virus) (ii) Bacterial (Example: Streptococcal)  ;

- Erythema elevatum diutinum - Dermatopathology Quiz Case 190

Image

Direct antibody mediated:

Antiendothelial cell antibody (AECA)

- Kawasaki disease  

- Lupus Vasculitis

Antineutrophilic cytoplasmic antibody (ANCA) 

- Wegener's granulomatosis 

- Microscopic polyangitis 

- Churg-Strauss Syndrome - Image 12 

- Some drug related vasculitis (Example: Thiouracil)

Cell-mediated: Allograph rejection.

 

Unknown:

- Giant cell (temporal) arteritis 

- Takayasu arteritis

- Polyarteritis nodosa Image12  

- Granuloma faciale  - Dermatopathology Quiz Case 75

 

Chronic Lymphocytic Vasculitis:

This is a number of clinically heterogeneous disease which on histopathological examination displays lymphocytic infiltrate involving and surrounding the small vessels in the dermis.

There is associated endothelial swelling , extravasation of erythrocytes and extravasation of fibrin into vessel wall.

Example:

Toxic erythema 

Collagen vascular disease

Pityriasis Lichenoides Image 

Prurigo of pregnancy

Pigmented purpuric dermatosis 

Perniosis ; Dermatopathology Case 76

Pyoderma Gangrenosum

Rickettsial and viral infection

Polymorphous Light Eruption Image ; Dermatopathology Case 84

 

                                                                      

Vasculitis with Granulomatosis: Characterized by varying degrees of granulomatosis (angiocentric and unrelated to vessels) together with vasculitis.

Example: 

Wegener's granulomatosis

Lymphomatoid granulomatosis 

Allergic Granulomatosis (Churg-Strauss Syndrome) ; Dermatopathology Case 104

Midline granuloma;

Temporal arteritis.

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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