title: Histopathology of bilateral lower extremity inflammatory lymphedema in military basic trainees: A leukocytoclastic vasculitis of the deep vascular plexus.
abstract: Bilateral lower extremity inflammatory lymphedema (BLEIL) is a recently described condition that presents with exquisite tenderness, erythema and edema of the lower leg, ankle and dorsal foot resembling an acute cellulitis. It was first reported in healthy, young adult military basic trainees with a normal body mass index during the first 72 hours of arrival to basic training. It occurs while standing at attention for many hours, and shows rapid resolution with elevation and rest. We report an additional case of BLEIL and describe the histopathology of this case and 2 of the previously reported cases. All 3 biopsies showed a deep perivascular infiltrate of neutrophils with karyorrhectic debris and prominent red blood cell extravasation. One of the 3 cases was positive for complement by direct immunofluorescence. We postulate this condition represents a deep leukocytoclastic vascultis with secondary reactive lymphedematous changes.
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, Department of Dermatology, Joint Base San Antonio- Lackland, Texas.
authors.forename: Shannan E
authors.identifier: http://orcid.org/0000-0002-6665-757X
authors.initials: SE
authors.lastname: McCann
authors.affiliation: San Antonio Uniformed Services Health Education Consortium, Department of Dermatology/Department of Pathology, Joint Base San Antonio, Texas.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Dalton
authors.affiliation: Colorado Springs Health Partners PC, Department of Dermatology and Dermatopathology, Colorado Springs, Colorado.
authors.forename: Todd T
authors.initials: TT
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008209:Lymphedema / Q000378:metabolism / Q000473:pathology; D008297:Male; D020556:Neutrophil Infiltration; D009504:Neutrophils / Q000378:metabolism / Q000473:pathology; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000378:metabolism / Q000473:pathology
keywords: leukocytoclastic vasculitis; lymphedema; military; prolonged standing; trainees