title: Leukocytoclastic vasculitis associated with perforated diverticular disease.
abstract: Leukocytoclastic vasculitis (LV) is a small vessel vasculitis associated with infections, connective tissue disease, malignancies and, rarely, gastrointestinal conditions. An association between LV and acute diverticulitis has not previously been reported. LV may be localised to the skin as a purpuric rash or might manifest with systemic involvement, such as of the joints, gastrointestinal tract or kidneys. Management of LV can be medical or surgical, based on the degree of systemic involvement. We present the case of a 56-year-old man with a 2-year history of a purpuric rash associated with diarrhoea, who presented acutely with abdominal pain. Imaging studies revealed sigmoid diverticulitis with a pericolic collection. Operative findings were purulent peritonitis secondary to perforated diverticular abscess, which was treated with a Hartmann's procedure. Postoperatively, the purpuric rash resolved rapidly on treatment with antibiotics and steroids. Histopathology of the resected bowel and skin punch biopsy confirmed sigmoid diverticulitis and LV, respectively.
authors.affiliation: Department of Surgery, Medway Maritime Hospital, Gillingham, Kent, UK.
authors.forename: Amalachukwu Michael
authors.initials: AM
authors.lastname: Okpala
authors.affiliation: Department of Surgery, Medway Maritime Hospital, Gillingham, Kent, UK.
authors.forename: Meera
authors.initials: M
authors.lastname: Joshi
authors.affiliation: Department of Surgery, Medway Maritime Hospital, Gillingham, Kent, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Andrews
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000038:Abscess / Q000150:complications* / Q000601:surgery; D012809:Colon, Sigmoid / Q000473:pathology* / Q000601:surgery; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery; D004241:Diverticulum, Colon / Q000150:complications / Q000601:surgery; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D012867:Skin / Q000473:pathology; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery