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- Title
Studies on a patient with leucocytoclastic vasculitis 'pyoderma gangrenosum' and paraproteinaemia.
- Authors
Thompson, Dorothy M.; Main, Robert A.; Beck, J. Swanson; Albert-Recht, Frank
- Abstract
A patient with leucocytoclastic vasculitis, pyoderma gangrenosum, chronic pyelonephritis and a paraprotein of IgA type is described. The vasculitis responded favourably to dapsone therapy, while the pyoderma gangrenosum improved only when steroids were also given. During an exacerbation following withdrawal of dapsone, the serum IgG level fell early, but the β1C-globulin level remained normal. Immunofluorescence studies on a vasculitic lesion showed granular deposits of IgG and β1C in the walls of the blood vessels and a more extensive exudate of fibrin. Skin testing with bacterial antigens and patch testing to potassium iodide produced lesions which clinically, histologically and immunologically resembled the spontaneous vasculitic lesion. The pathological term leucocytoclastic vasculitis embraces the clinical conditions of pentasymptome of Gougerot and erythema elevatum diutinum. The overlap in the clinical features of these disorders is considerable and a remarkable improvement with dapsone therapy has been described in both (Vollum, 1968; Wells, 1969; Cream, Levene & Calnan, 1971). The distinction between the two would appear to be artificial. The aetiology of leucocytoclastic vasculitis may be a naturally occurring Arthus reaction (Cochrane & Weigle, 1968; Stringa et al., 1967). In the light of our present ignorance ‘pyoderma gangrenosum’ remains only a clinical entity and describes a chronic indolent ulcer with undermined edges and with a tendency to heal at the centre while still extending at its periphery. An association with a number of immunopathological disorders has been noted.
- Subjects
VASCULAR diseases; PARAPROTEINEMIA; SKIN infections; VASCULITIS; IMMUNOGLOBULIN G; IMMUNOLOGIC diseases
- Publication
British Journal of Dermatology, 1973, Vol 88, Issue 2, p117
- ISSN
0007-0963
- Publication type
Article