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Microscopic polyarteritis. Report of a case with cutaneous involvement and antimyeloperoxidase antibodies
P B Homas1, K M David-Bajar, J E Fitzpatrick
1Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colo 80045-5001.
Background:
Microscopic polyarteritis is a systemic small-vessel vasculitis that primarily involves the kidneys but may also affect the skin and other organ systems. This unique vasculitis represents one of the vasculitides with antineutrophil cytoplasmic antibodies, usually of the perinuclear immunostaining pattern (P-ANCA, antimyeloperoxidase antibodies). The objective of this case report is to describe microscopic polyarteritis, the use of antineutrophil cytoplasmic antibodies, and the unique cutaneous histopathologic features of our patient.
Observations:
We describe a patient with clinical findings consistent with microscopic polyarteritis, the presence of antimyeloperoxidase antibodies, and a specific cutaneous leukocytoclastic vasculitis. This report further characterizes the histopathologic features by demonstrating that the anatomic location of the cutaneous vasculitic lesions is at the level of the dermal arteriolar vessels and postcapillary venules.
Conclusions:
Cutaneous arteriolar leukocytoclastic vasculitis may prove to be a histologic hallmark of microscopic polyarteritis when it presents in the skin. However, further case comparisons and histopathologic investigations are needed. The consequences of this systemic vasculitis, if not adequately treated, may be life threatening. Recognition of clinical features, use of antineutrophil cytoplasmic antibodies, and demonstration of a cutaneous arteriolar leukocytoclastic vasculitis may aid in the diagnosis and subsequent treatment of patients followed up by dermatologists for vasculitic ulcers.
Insights
Microscopic polyarteritis, a small-vessel vasculitis, often involves the kidneys and skin. Antimyeloperoxidase antibodies and specific skin lesions may aid diagnosis.
Area of Science:
- Dermatology
- Rheumatology
- Pathology
Background:
- Microscopic polyarteritis is a systemic small-vessel vasculitis affecting kidneys, skin, and other organs.
- It is associated with antineutrophil cytoplasmic antibodies, typically perinuclear ANCA (P-ANCA) with antimyeloperoxidase antibodies.
Observation:
- This case report details a patient with microscopic polyarteritis, antimyeloperoxidase antibodies, and cutaneous leukocytoclastic vasculitis.
- Histopathology revealed vasculitic lesions located in dermal arteriolar vessels and postcapillary venules.
Findings:
- Cutaneous arteriolar leukocytoclastic vasculitis may be a key histologic feature of microscopic polyarteritis presenting in the skin.
- Further research is needed to confirm this finding through comparative case studies and histopathologic investigations.
Implications:
- Early recognition of clinical signs, ANCA testing, and identifying cutaneous arteriolar leukocytoclastic vasculitis can improve diagnosis and treatment.
- Untreated microscopic polyarteritis can have life-threatening consequences.