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Soon Bahrami, MD; Janine C. Malone, MD; Kelli G. Webb, MD; Jeffrey P. Callen, MD

Arch Dermatol. 2006;142:155-161.

Objective  To determine whether tissue eosinophilia is a reliable indicator of a drug-induced etiology in biopsy samples demonstrating leukocytoclastic vasculitis.

Design  Retrospective medical record review with concurrent histopathologic analysis.

Setting  University-affiliated dermatology practice.

Patients  Sixty-three patients with cutaneous small-vessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non–drug-induced (n = 47) groups.

Main Outcome Measures  Corresponding histopathologic material was reviewed by a dermatopathologist masked to the etiologic associations. An eosinophil ratio was calculated for each patient, derived from the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields), and expressed in relation to the intensity of inflammation in the histopathologic slides examined. Eosinophilia ratios were compared for both groups using the Mann-Whitney test.

Results  A significant difference was found in mean eosinophil ratios in the drug-induced vs non–drug-induced groups (5.20 vs 1.05; P = .01). Vascular fibrin deposition was present in both groups and was not found to be significantly different (P = .78). Clinical evidence of systemic vasculitis was present in 2 patients (13%) in the drug-induced group vs 15 (32%) in the non–drug-induced group. Fourteen patients (88%) in the drug-induced group had a short-term disease course vs 27 (57%) in the non–drug-induced group.

Conclusions  Tissue eosinophilia is established as a reliable indicator of drug induction in cutaneous small vessel vasculitis. Drug-induced small-vessel vasculitis generally follows a short-term disease course without development of systemic involvement. This information may be useful for guiding management decisions, especially when the etiology is unclear.

Author Affiliations: Department of Pathology (Drs Bahrami and Malone) and Division of Dermatology, Department of Internal Medicine (Drs Malone, Webb, and Callen), University of Louisville School of Medicine, Louisville, Ky.

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