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A Newly Described Medium-Sized Vessel Arteritis of the Skin

Joyce Siong-See Lee, MMED(UK), FAMS; Steven Kossard, FACD; Michael A. McGrath, MD, FRACP

Arch Dermatol. 2008;144(9):1175-1182.

Background  We encountered a distinct arteriolar histopathologic finding of lymphocytic vasculitis associated with a hyalinized fibrin ring in vessel lumina. Identical histologic findings have previously been described as macular arteritis.

Observations  We describe 5 women (mean age, 25 years; age range, 20-34 years) with persistent, slowly progressive, patchy and reticular hyperpigmentation associated with livedo racemosa affecting predominantly the lower limbs. In the biopsy samples, infiltration of muscular vessel wall by inflammatory cells, affecting small arteries of the dermosubcutaneous junction or superficial subcutis, was present. Of the infiltrate, 90% or more consisted of mononuclear cells, mainly lymphocytes with an admixture of histiocytes. Neutrophils and eosinophils were absent or scant. Inflammation was confined to the vicinity of the vessel and the immediate surrounding panniculus. A concentric fibrin ring involving the entire periphery of the lumina of affected vessels was present in all the patients. Laboratory investigation results revealed that 4 patients had antiphospholipid antibodies in their serum. One of these patients had a heterozygous mutation of the factor V Leiden gene.

Conclusion  We term this arteritis lymphocytic thrombophilic arteritis to reflect the histologic features that combine lymphocytic vascular inflammation with changes representing a thrombophilic endovasculitis.

Author Affiliations: Skin and Cancer Foundation Australia, Sydney, New South Wales (Drs Lee and Kossard); and Vascular Medicine, St Vincent's Hospital and St Vincent's Clinic, University of New South Wales, Darlinghurst, Sydney (Dr McGrath). Dr Lee is a visiting fellow from the National Skin Centre, Singapore.

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