Cutaneous Vasculitis

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Abstract
I FIRST became interested in the subject of vasculitis in 1973 while caring for a previously healthy 17-year-old boy who suddenly developed generalized palpable purpura and large areas of reticulated necrosis of his skin. Gastrointestinal tract symptoms and signs predated the onset of his eruption, and several drugs had been administered simultaneously with the onset of the eruption. Examination of the gastrointestinal tract disclosed purpuric lesions similar to those observed on the skin. Hematuria and proteinuria were also present. A biopsy specimen of the skin failed to show a small-vessel vasculitis, but a biopsy specimen of affected bowel demonstrated a leukocytoclastic vasculitis. A diagnosis of ulcerative colitis was also confirmed. Eventually, recovery occurred with oral corticosteroid treatment and conservative local care. At our grand rounds, I remember our faculty arguing about how to best classify this patient: (1) Had he had Henoch-Schönlein purpura, hypersensitivity vasculitis, or polyarteritis nodosa? (2) What should the optimal treatment have been: observation, corticosteroids, or immunosuppressives? (3) What was his prognosis? This patient's case resulted in my first publication in the ARCHIVES on the subject of cutaneous vasculitis.1