Resident Dermatologist: Maeve Maher, MD

Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

HISTORY:

51 y/o male with past medical history significant for atrial fibrillation, hypertension, hyperlipidemia, & tobacco abuse presented to outside hospital with 1 week of rash and swelling of lower legs. The rash was not pruritic and was slightly tender given the swelling of his legs. The rash eventually spread to his abdomen and arms, and treatment was started with oral prednisone. He had been in his normal state of health except for this rash but he was started on a new medication, which was sotalol. He was eventually admitted to the outside hospital because of hyperglycemia likely due to the prednisone. A skin biopsy was performed for histopathologic evaluation.

Red, non-blanchable, flat-topped papules scattered on left lower leg.

Low power magnification demonstrates an infiltrate in the superficial and mid-reticular dermis in the distribution of small-sized blood vessels.

At high power, blood vessels are no longer intact, and instead are replaced by bright pink fibrin (red arrows). There are surrounding neutrophils and fragments of neutrophils, i.e. “leukocytoclasis”, and extravasated erythrocytes (yellow arrow).

What is the most likely diagnosis?

  1. Leukocytoclastic vasculitis
  2. Pigmented purpuric dermatosis
  3. Stasis dermatitis
  4. Idiopathic thrombocytopenic purpura
Leukocytoclastic vasculitis