Necrotizing vasculitis. Etiologic aspects of immunology and coagulopathy

Thirty-one patients with cutaneous necrotizing vascultis were studied for immunological and coagulation disturbances. Serum immunoglobulin levels did not correlate with tissue deposition of the corresponding immunoglobulins in the lesions of cutaneous necrotizing vasculitis. In all instances, localization of immunoglobulins, complement, and fibrinogen, when present in the lesions of necrotizing vasculitis, was limited to the vascular wall or perivascular space. Soluble fibrinogen-fibrin complexes (cryoprofibrin) were detected in the blood of four of 17 patients with cutaneous necrotizing vasculitis. Since it represents a product of the limited action of thrombin on fibrinogen, its presence in the blood in some patients with necrotizing vasculitis suggests that intravascular coagulation may play a part in the pathogenesis of the disease. In 12 of the 31 patients studied, a cause of the vasculitis was found or presumed.