Leukocytoclastic vasculitis

Left leg 2013-03-17, the day before my birthday. I didn't photograph my other leg at the time because I was just trying to show mom the LV itself, not the secondary infection that had set in on the right leg. Also, I was in intense pain, so I wasn't exactly thinking about chronicling.

This article is a stub. I'll get around to lengthening it when I feel like it :)

TL;DR

For the TL;DR crowd: In February I developed a condition called leukocytoclastic vasculitis, which is essentially a disease where the immune system decides your blood vessels are foreign invaders and attempts to destroy them. It appears to be chronic, however, there doesn't appear to be internal organ involvement, and it looks like we're finally getting it under control with oral steroids.

2013-06-27: *Deep breath* Here goes...

When your dermatologist hands you a copy of the page from her reference book and you see the first line includes "small-vessel necrotizing vasculitis", the teenage boy in you reading his mom's medical encyclopedia starts shouting "Cool! I have something with necrotizing in the description!", but then the middle-aged man in you kicks in and says "YOU FOOL! DON'T YOU UNDERSTAND THAT MEANS DEATH! YOUR OWN IMMUNE SYSTEM IS OUT TO KILL YOU!" However, the teenager mumbles under his breath as he goes out the door, "I still think it's cool."

Leukocytoclastic vasculitis is the most common form of small-vessel necrotizing vasculitis[...]   The characteristic lesions are referred to as palpable purpura. The lesion begins as a localized area of cutaneous hemorrhage that acquires substance and becomes palpable as blood leaks out of damaged venules. Nodules, bullae, and ulcers may arise from these purpuric areas and indicate more severe vessel imflamation and necrosis[...]   Prodromal symptoms include fever, malaise, myalgia, and joint pain. Small lesions itch and are painful; nodules, ulcers, and bullae may be very painful.   Lesions appear in crops and last 1 to 4 weeks. Recurrences are common and new crops may appear for weeks, months, or years. Clinical Dermatology: A Color Guide to Diagnosis and Therapy, page 376

Today is my father's birthday and I wanted to call him to say hi, however, I know he's going to ask me if I'm coming to the annual family get-together, and I need to

Go to an ER now! secondary infection Sick Leave Rash on back and arms, abdomen stages (rash/itch, purpura/sensitivity, RLS from hell (acid needle), oozing/ice pick hypersensitivity hypersensitivity, screaming malaise, insomnia Scare with bloody underwear Ulcerations blood in all pieces of clothing.... *sigh*

 bloody socks are a regular thing.

Biopsy results

On 2013-05-10 I went in to a surgeon to get a two-punch biopsy on a fresh lesion. The biopsy results indicated the following:

COMMENT: THE HISTOLOGIC CHANGES SUGGEST A MIXED VASCULITIC PROCESS OF MEDIUM AND SMALL-SIZED BLOOD VESSELS WITH SOME AREAS THAT ARE LEUKOCYTOCLASTIC IN OTHERS WHICH ARE LYMPHOID. THE SECOND TISSUE SAMPLE FRAGMENT HAS BEEN SUBMITTED FOR IMMUNOFLUORESCENCE STUDIES WHICH WILL BE CORRELATED IN AN AMMENDMENT TO THIS REPORT Surgical Pathology Report

The findings are non-specific and do not follow a recognizable pattern of immunopathological disease. Dermatopathology Report *Amended*

Translation: "Yeah, it's leukocytoclastic vasculitis, but we don't have a clue what's causing it." The rheumatologist gave the analogy of being set down from a balloon in the middle of a cornfield. You know you are in a cornfield, but you don't have a clue what country you are in.

Epidemiology

The occurrence of leukocytoclastic vasculitis in adults is rare. Studies in the UK, Spain, etc. have shown rates ranging from 10-40 adults per million per year. Anecdotally my dermatologist sees about ten cases per year (including children) and my rheumatologist has seen about 10 cases in his entire career. While a the surface these seem contradictory, it's not. The dermatologist's numbers include children where it is known as Henoch-Schönlein purpura. Dermatologists are usually the first line of defense and the condition is often only referred to a rheumatologist when it becomes apparent that it is likely chronic. In children, the condition usually goes away quickly and is rarely chronic.

Watts, et al:

---

• Leukocytoclastic Vasculitis Images
• Images of my progress with leukocytoclastic vasculitis
• 

  2013-03-17
  Left leg the day before my birthday. I didn't photograph my other leg at the time because I was just trying to show mom the LV itself, not the secondary infection that had set in on the right leg. Also, I was in intense pain, so I wasn't exactly thinking about chronicling.

• 

  2013-04-19
  Both legs a month later. A second outbreak had occurred on the backs of my legs, but by this time was finally clearing up and we were hoping things were over. A new outbreak on my feet and ankles would start 2 days later. This round also started showing ulcerations on the thigh and ankle.

• 

  2013-04-22
  The beginning of the third round of LV outbreaks. This was the one that prompted my dermatologist to turn me over to a rheumatologist, since it was starting to look like a chronic condition.

• 

  2013-05-24
  The beginning of the fourth round of LV outbreaks. You can see how large the third round ankle spot got.

• 

  2013-06-20
  Fourth round of LV outbreaks is finally healing after treatment with oral steroids. You can see the swelling has gone down considerably between the previous picture and this one.