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 © 2001-2010, DermAtlas | Image Name: | cryoglobulinemia_typeII_1_070201 | File Type: | jpg | |
| Diagnosis: | CRYOGLOBULINEMIA | Category: | vasculopathy / cutaneous sign of systemic disease | ||
| Body Site: | leg | Age: | 36 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | This biopsy shows massive purpura and leukocytoclasia throughout the interstitium. The overlying epidermis appears in its early stages of breaking down. | ||||
| Comments: | This young patient has hepatitis C and developed palpable purpura on his lower extremities. He is hypergammaglobulinemic. Histologically, he has leukocytoclastic vasculitis. These findings are consistent with type II cryoglobulinemia. This type often shows on immunofixation electrophoresis assays to have both a monoclonal and polyclonal component to their gammaglobulins. | ||||
| Related Images: | cryoglobulinemia_typeII_2_070201 | ||||
 © 2001-2010, DermAtlas | Image Name: | cryoglobulinemia_typeI_2_070201 | File Type: | jpg | |
| Diagnosis: | CRYOGLOBULINEMIA | Category: | cutaneous sign of systemic disease / vasculopathy | ||
| Body Site: | leg | Age: | 55 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | Within the lumen of the vessels there is abundant pick amorphous material. Morphologically, this material is too bright and glassy for fibrin. An inflammatory infiltrate is minimal. | ||||
| Comments: | This is a good example of type I cryoglobulinemia. This patient had a monoclonal gammopathy from lymphoma. Histologicallly, there is occlusion of vessels without vasculitis. The occlusive material is PAS positive (not shown) and represents immunoglobulin precipitates. Due to the laboratory requirements on specimen handling, cryoglobulinemia can be a difficult diagnosis to make, and therefore getting a biopsy like this is met with relief. | ||||
| Related Images: | cryoglobulinemia_typeI_1_070201 | ||||
 © 2001-2010, DermAtlas | Image Name: | cryoglobulinemia_typeI_1_070201 | File Type: | jpg | |
| Diagnosis: | CRYOGLOBULINEMIA | Category: | cutaneous sign of systemic disease / vasculopathy | ||
| Body Site: | leg | Age: | 55 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | There is a thrombo-occlusive process involving the superficial dermis. The overlying epidermis shows evidence of insult. A significant inflammatory infiltrate is not present. | ||||
| Comments: | This is a good example of type I cryoglobulinemia. This patient had a monoclonal gammopathy from lymphoma. Histologicallly, there is occlusion of vessels without vasculitis. The occlusive material is PAS positive (not shown) and represents immunoglobulin precipitates. Due to the laboratory requirements on specimen handling, cryoglobulinemia can be a difficult diagnosis to make, and therefore getting a biopsy like this is met with relief. | ||||
| Related Images: | cryoglobulinemia_typeI_2_070201 | ||||
 © 2001-2010, DermAtlas | Image Name: | cryoglobulinemia_typeII_2_070201 | File Type: | jpg | |
| Diagnosis: | CRYOGLOBULINEMIA | Category: | vasculopathy / cutaneous sign of systemic disease | ||
| Body Site: | leg | Age: | 36 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | The vessels appear occluded with eosinophilic material. There are numerous neutrophils in the interstitium with leukocytoclasia. | ||||
| Comments: | This young patient has hepatitis C and developed palpable purpura on his lower extremities. He is hypergammaglobulinemic. Histologically, he has leukocytoclastic vasculitis. These findings are consistent with type II cryoglobulinemia. This type often shows on immunofixation electrophoresis assays to have both a monoclonal and polyclonal component to their gammaglobulins. | ||||
| Related Images: | cryoglobulinemia_typeII_1_070201 | ||||
 © 2001-2010, DermAtlas | Image Name: | vasculitis_3_021113 | File Type: | jpg | |
| Diagnosis: | VASCULITIS / VASCULITIS, LEUKOCYTOCLASTIC / CRYOGLOBULINEMIA | Category: | collagen vascular disease / Metabolic disorders | ||
| Body Site: | leg / shin | Age: | 43 years | ||
| Contributor: | Michael Viglione, MD | ||||
| Description: | In the superficial dermis there is disruption of small vessels by neutrophils with leukocytoclasis, extravasation of red blood cells, and a lymphocytic perivascular infiltrate. | ||||
| Comments: | These changes are characteristic of leukocytoclastic vasculitis. | ||||
| Related Images: | All related Images vasculitis_1_021113 vasculitis_2_021113 vasculitis_4_021113 | ||||
 © 2001-2010, DermAtlas | Image Name: | vasculitis_4_021113 | File Type: | jpg | |
| Diagnosis: | VASCULITIS / VASCULITIS, LEUKOCYTOCLASTIC / CRYOGLOBULINEMIA | Category: | collagen vascular disease / Metabolic disorders | ||
| Body Site: | leg / shin | Age: | 43 years | ||
| Contributor: | Michael Viglione, MD | ||||
| Description: | In the superficial dermis there is disruption of small vessels by neutrophils with leukocytoclasis, extravasation of red blood cells, and a lymphocytic perivascular infiltrate. | ||||
| Comments: | These changes are characteristic of leukocytoclastic vasculitis. | ||||
| Related Images: | All related Images vasculitis_1_021113 vasculitis_2_021113 vasculitis_3_021113 | ||||
 © 2001-2010, DermAtlas | Image Name: | vasculitis_2_021113 | File Type: | jpg | |
| Diagnosis: | VASCULITIS / VASCULITIS, LEUKOCYTOCLASTIC / CRYOGLOBULINEMIA | Category: | purpura / collagen vascular disease | ||
| Body Site: | leg / shin | Age: | 43 years | ||
| Contributor: | Raquel Charles | ||||
| Description: | multiple symmetric 2-3 mm purpuric papules | ||||
| Comments: | This 43 year old woman was admitted to the hospital for evaluation of acute worsening of leg pain and weakness that started 10 months earlier. During her hospitalization she developed purpuric papules on her lower legs. A skin biopsy showed a leukocytoclastic vasculitis and direct immunofluorescence demonstrated IgG, M and C3 in dermal blood vessels consistent with polyarteritis nodosa. Laboratory studies revealed cryoglobulinemia with a monoclonal IgM kappa and polyclonal IgG, A, and M. These findings were most consistent with mixed cryoglobulinemia that is often associated with collagen vascular disease. For more details see the cme discussion. | ||||
| Related Images: | All related Images vasculitis_1_021113 vasculitis_4_021113 vasculitis_3_021113 | ||||
 © 2001-2010, DermAtlas | Image Name: | vasculitis_1_021113 | File Type: | jpg | |
| Diagnosis: | VASCULITIS / VASCULITIS, LEUKOCYTOCLASTIC / CRYOGLOBULINEMIA | Category: | purpura / collagen vascular disease | ||
| Body Site: | leg / shin | Age: | 43 years | ||
| Contributor: | Raquel Charles | ||||
| Description: | multiple symmetric 2-3 mm purpuric papules | ||||
| Comments: | This 43 year old woman was admitted to the hospital for evaluation of acute worsening of leg pain and weakness that started 10 months earlier. During her hospitalization she developed purpuric papules on her lower legs. A skin biopsy showed a leukocytoclastic vasculitis and direct immunofluorescence demonstrated IgG, M and C3 in dermal blood vessels consistent with polyarteritis nodosa. Laboratory studies revealed cryoglobulinemia with a monoclonal IgM kappa and polyclonal IgG, A, and M. These findings were most consistent with mixed cryoglobulinemia that is often associated with collagen vascular disease. For more details see the cme discussion. | ||||
| Related Images: | All related Images vasculitis_2_021113 vasculitis_4_021113 vasculitis_3_021113 | ||||
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