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Editorial |

The Enigma of Lymphocytic Vasculitis

Philip E. LeBoit, MD
Arch Dermatol. 2008;144(9):1215-1216. doi:10.1001/archderm.144.9.1215.
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Few clinicians are in much doubt as to what a histopathologist's diagnosis of leukocytoclastic vasculitis means. Few histopathologists are in much doubt as to how to make this diagnosis. If one finds, on microscopic examination, that there are neutrophils in and around the walls of cutaneous venules, accompanied by deposits of fibrin in vessel walls and by neutrophilic nuclear dust, there is a clear meaning to these changes. One can look for ancillary clues (eg, fibrosis in the case of erythema elevatum diutinum and granulomas interstitially in Wegener granulomatosis), but the basic path to a specific diagnosis has been laid out many times.

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This biopsy specimen (hematoxylin-eosin for all panels) comes from a 58-year-old woman with seropositive rheumatoid arthritis, a high titer speckled antinuclear antibody finding, and a livedoid eruption on her legs. A, Note that the epidermis is thinned and shows vacuolar changes; dense lymphocytic infiltrates are visible around vessels and adnexa in both the superficial and deep dermis (original magnification ×20). B, Lymphocytes are present beneath the junctional zone where vacuolar change is present and around venules, and fibrin deposition is apparent in the venule walls (ie, lymphocytic vasculitis)(original magnification ×40). C, Lymphocytic vasculitis is present in the deep dermis as well, indicating more than just chance association (original magnification ×100).

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