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Report of a Case With Cutaneous Involvement and Antimyeloperoxidase Antibodies

CPT Pamela Bostic Homas, MC; MAJ Kathleen M. David-Bajar, MC; LTC James E. Fitzpatrick, MC; LTC Sterling G. West, MC; MAJ Dwight R. Tribelhorn, MC

Arch Dermatol. 1992;128(9):1223-1228.

Abstract
• Background.—
Microscopic polyarteritis is a systemic small-vessel vasculitis that primarily involves the kidneys but may also affect the skin and other organ systems. This unique vasculitis represents one of the vasculitides with antineutrophil cytoplasmic antibodies, usually of the perinuclear immunostaining pattern (P-ANCA, antimyeloperoxidase antibodies). The objective of this case report is to describe microscopic polyarteritis, the use of antineutrophil cytoplasmic antibodies, and the unique cutaneous histopathologic features of our patient.

Observations.—
We describe a patient with clinical findings consistent with microscopic polyarteritis, the presence of antimyeloperoxidase antibodies, and a specific cutaneous leukocytoclastic vasculitis. This report further characterizes the histopathologic features by demonstrating that the anatomic location of the cutaneous vasculitic lesions is at the level of the dermal arteriolar vessels and postcapillary venules.

Conclusions.—
Cutaneous arteriolar leukocytoclastic vasculitis may prove to be a histologic hallmark of microscopic polyarteritis when it presents in the skin. However, further case comparisons and histopathologic investigations are needed. The consequences of this systemic vasculitis, if not adequately treated, may be life threatening. Recognition of clinical features, use of antineutrophil cytoplasmic antibodies, and demonstration of a cutaneous arteriolar leukocytoclastic vasculitis may aid in the diagnosis and subsequent treatment of patients followed up by dermatologists for vasculitic ulcers.

(Arch Dermatol. 1992;128:1223-1228)

Author Affiliations
USA; USA; USA; USA; USA

From the Department of Medicine, Dermatology (Drs Homas, David-Bajar, Fitzpatrick, and Tribelhorn) and Rheumatology (Dr West) Services, Fitzsimons Army Medical Center, Aurora, Colo.

Footnotes
Accepted for publication January 22, 1992.

The opinions or assertions contained herein are the views of the authors and are not to be considered as reflecting the views of the Department of the Army or the Department of Defense.

Reprint requests to Dermatology Service, HSHG-MDD, Bldg 418, Fitzsimons Army Medical Center, Aurora, CO 80045-5001 (Dr Homas).

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