Henoch-Schönlein purpura: clinicopathologic correlation of cutaneous vascular IgA deposits and the relationship to leukocytoclastic vasculitis.
Significant cutaneous vascular IgA deposits are common in Henoch-Schönlein purpura but not in other vasculitides. The specificity for IgA vascular deposits for Henoch-Schönlein purpura is not well defined. To examine the specificity of IgA vascular deposits for this disease, we compared clinicopathologic features of 92 cases with IgA vascular deposits and a direct immunofluorescence impression of vasculitis with 90 similar cases without IgA deposits. Henoch-Schönlein purpura was diagnosed in 24% of cases with vascular IgA deposits on direct immunofluorescence examination. IgA deposits were frequent in erythema nodosum and venous stasis-related problems and in cryoglobulinemia, coagulopathic vasculopathies, and livedoid vasculitis. Of our cases, 78% exhibited vascular fluorescence with multiple conjugates. No histologic or immunofluorescence pattern alone was specific. The diagnostic specificity for Henoch-Schönlein purpura is improved if gastrointestinal involvement, upper respiratory infection, or age < 20 years is present. We propose diagnostic criteria for Henoch-Schönlein purpura incorporating clinical findings yielding sensitivity and specificity > 90%.
Helander
S D
SD
Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
De Castro
F R
FR
Gibson
L E
LE
D001706:Biopsy; D005455:Fluorescent Antibody Technique; D006801:Humans; D011695:IgA Vasculitis / Q000276:immunology* / Q000473:pathology* / Q000503:physiopathology; D007070:Immunoglobulin A / Q000032:analysis*; D012680:Sensitivity and Specificity; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000276:immunology* / Q000473:pathology* / Q000503:physiopathology
D007070:Immunoglobulin A