title: Histopathologic differences between cutaneous vasculitis associated with severe bacterial infection and cutaneous vasculitis secondary to other causes: study of 52 patients.
abstract: OBJECTIVE
  To determine if cutaneous vasculitis (CV) associated with severe infection has some histopathologic findings that may help us to differentiate patients with this condition from other patients with CV.
  
  
  METHODS
  We reviewed the skin biopsy specimens of patients with leukocytoclastic CV associated with a severe bacterial infection. Histopathologic findings of these patients were compared with those observed in leukocytoclastic CV secondary to other causes. Biopsy-proven leukocytoclastic CV were stratified as follows: group a): CV associated with severe underlying bacterial infection; group b): CV without severe bacterial infection but with systemic involvement; group c): CV without systemic involvement. Slides were reviewed by expert pathologists that were blind to the clinical information. The severity of vascular lesions was measured according to a semiquantitative scale (Hodge index). A comparative study between group a) and the other groups was conducted.
  
  
  RESULTS
  group a) included 12 patients (2 women/10 men), mean age± SD 56±15 years; group b) 21 patients (10 women/11 men), 52±18 years; and group c) 19 patients (12 women/7 men), 59±24 years. Presence of neutrophilia was significantly increased in biopsies from group a) when compared with the other two groups. Also, a trend to higher frequency of pustular dermatosis was found in patients from group a). Hodge index, degree of inflammatory infiltrate and deep arterioles involvement were similar in all groups.
  
  
  CONCLUSIONS
  Neutrophilia is common in skin biopsies of patients with CV associated with severe bacterial infection. No other histopathological findings help us to establish the presence of a severe underlying infection.
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Vela
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: Department of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Armesto
authors.affiliation: Department of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Marcos Antonio
authors.initials: MA
authors.lastname: González-López
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortiz-Sanjuán
authors.affiliation: Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: José Fernando
authors.initials: JF
authors.lastname: Val-Bernal
authors.affiliation: Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hermana
authors.affiliation: Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Arantza
authors.initials: A
authors.lastname: Onaindia-Pérez
authors.affiliation: Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain. miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017445:Skin Diseases, Vascular / Q000209:etiology / Q000473:pathology*; D014657:Vasculitis / Q000209:etiology / Q000473:pathology*