Published: 2016-09-03

Necrotizing leukocytoclastic vasculitis mimicking necrotizing fasciitis: a case report

Mehmet Salih Soylemez, Korhan Ozkan, Bulent Kılıc, Samet Erinc, Irfan Esenkaya, Bahar Ceyran


There are several subtypes of necrotizing leukocytoclastic vasculitis, which are classified according to their morphological features in biopsy specimens using immunofluorescence microscopy. Necrotizing leukocytoclastic vasculitis is limited to the skin, predominantly that of the lower extremities, and usually spares the palms and soles. The most common skin manifestation is palpable purpura. Other skin manifestations include maculopapular rash, bullae, papules, nodules, ulcers and livedo reticularis. There is no specific laboratory test to determine the diagnosis. There are various diseases presenting with these nonspecific symptoms, and a rapid differential diagnosis must be conducted, because the appropriate differentiation and diagnosis markedly influence the treatment strategy and survival of patients. In this study, we report a case of necrotizing leukocytoclastic vasculitis presenting with internal organ involvement and symptoms of necrotizing fasciitis, with emphasis on the clinical differentiation.


Leukocytoclastic vasculitis, Differential diagnosis, Necrotizing fasciitis

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Koutkia P, Mylonakis E, Rounds S, Erickson A. Leucocytoclastic vasculitis: an update for the clinician. Scand J Rheumatol. 2001;30(6):315-22.

Das M, Chhabra R, Hinton SW. Cutaneous leukocytoclastic vasculitis and myelodysplastic syndrome with little or no evidence of associated autoimmune disorders – a case report and a brief review of the literature. Am J Med Sci. 2008;336(4):368-71.

Tsampau D, Buggiani G, Hercogova J, Lotti T. Cutaneous necrotizing vasculitis: a rational therapeutic approach. Dermatol Ther. 2012;25(4):335-9.

Chaudhry AA, Baker KS, Gould ES, Gupta R. Necrotizing fasciitis and its mimics: what radiologists need to know. AJR. Am. J. Roentgenol. 2015;204:128–39.

Smoller BR, McNutt NS, Contreras F. The natural history of vasculitis. What the histology tells us about pathogenesis. Arch Dermatol. 1990;126(1):84-9.

Dinato SL, Dinato MC, Dinato MM, Ribeiro MC, Yamashiro CY, Romiti N. Necrotizing vasculitis as a manifestation of hypersensitivity to propylthiouracil]. Arq Bras Endocrinol Metabol. 2009;53(3):374-7.

Brown K, Martin J, Zito S. Severe leukocytoclastic vasculitis secondary to the use of a naproxen and requiring amputation: a case report. J Med Case Rep. 2010;4:204.

Pongruangporn M, Ritchie DJ, Lu D, Marschall J. Vancomycin-associated leukocytoclastic vasculitis. Case Rep Infect Dis. 2011;2011:356-70.

Tancrede-Bohin E, Ochonisky S, Vignon-Pennamen M-D, Flageul B, Morel P, Rybojad M. Schonlein-Henoch purpura in adult patients: 438 predictive factors for IgA glomerulonephritis in a retrospective study of 57 cases. Arch Dermatol. 1997;133(4):438-42.

Irvine AD, Bruce IN, Walsh MY, Bingham EA. Microscopic polyangiitis: Delineation of a cutaneous-limited variant associated with antimyeloperoxidase autoantibody. Arch Dermatol. 1997;133(4):474-7.

Edlich RF, Cross CL, Dahlstrom JJ, Long WB: Modern concepts of the diagnosis and treatment of purpura fulminans. J Env Pathol Toxicol Oncol. 2008;27(3):191-6.

Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR. Am. J. Roentgenol. 1998;170:615–20.

Stephen R, Burnett J, Pavlides N. Musculosceletal Infections and Microbiology in AAOS. In: Lieberman JR, eds. Comperehensive Orthopaedic Review. Illinois, USA. 2009: 98-100.

Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85:1454–60.

Ten Holder SM, Joy MS, Falk RJ. Cutaneous and systemic manifestations of drug-induced vasculitis. Ann Pharmacother. 2002;36(1):130–47.

Machaczka M, Klimkowska M, Hägglund H. Unexpected cure from cutaneous leukocytoclastic vasculitis in a patient treated with N-butyldeoxynojirimycin (miglustat) for Gaucher disease. Adv Med Sci. 2012;1;57(1):169-73.

Daniel CL. Leukocytoclastic vasculitis and Henoch-Schonle in Purpura in Arthritis & Allied Conditions. Lippincott Williams & Wilkins. 15th edition. vol. 86. Philadelphia, USA. 2005: 1793–1797.