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Following penicillin treatment for pneumococcal pneumonia, a patient develops a palpable purpuric rash. Biopsy of the rash demonstrates vasculitis with hemorrhage into the skin. The involved arterioles and venules show fibrinoid necrosis and a neutrophilic infiltrate into the wall. Many of the neutrophils are fragmented. Which of the following is the most likely diagnosis?
O A. Allergic granulomatosis and angiitis
O B. Giant cell aiteritis
O C. Leukocytoclastic angiitis
O D. Polyarteritis nodosa
O E. Wegener granulomatosus
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cccccc...leukoclastic.. fragmented neutrophils
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GUYS
AAAAA NOT CORRECT
LOOK AT ROBBINS
In allergic granulomatosis and angiitis (Churg-Strauss syndrome), vascular lesions may be histologically similar to those of classic PAN or microscopic polyangiitis, but they characteristically have necrotizing vasculitis accompanied by granulomas with eosinophilic necrosis.[61] p-ANCAs are present in approximately 50% of patients. There is a strong association with allergic rhinitis, bronchial asthma, and eosinophilia. Vessels in the lung, heart, spleen, peripheral nerves, and skin are frequently involved by intravascular and extravascular granulomas, and infiltration of vessels and perivascular tissues by eosinophils is striking
BUT I THINK CCCCCCCCC IS CORRECT
MICROSCOPIC POLYANGIITIS (MICROSCOPIC POLYARTERITIS, HYPERSENSITIVITY, OR LEUKOCYTOCLASTIC VASCULITIS)
This type of necrotizing vasculitis generally affects arterioles, capillaries, and venules”vessels smaller than those involved in PAN.[60] In unusual cases larger arteries may be involved. In contrast to PAN, all lesions tend to be of the same age. It typically presents as "palpable purpura" involving the skin, or involvement of the mucous membranes, lungs, brain, heart, gastrointestinal tract, kidneys, and muscle. Skin biopsy is often diagnostic. In contrast to PAN, necrotizing glomerulonephritis (90% of patients) and pulmonary capillaritis are particularly common. The major clinical features are hemoptysis, arthralgia, abdominal pain, hematuria, proteinuria, hemorrhage, and muscle pain or weakness. In many cases, an immunologic reaction to an antigen such as drugs (e.g., penicillin), microorganisms (e.g., streptococci), heterologous proteins, and tumor antigens are the precipitating cause. In 70% of patients, p-ANCAs are present.
The most common drugs that can cause cutaneous vasculitis are antibiotics, particularly beta-lactam drugs
