Case Report

Cutaneous Vasculitis — A Case for Laparotomy?

LISA WILLCOCKS, GLADSTONE CHELLIAH, RACHEL BROWN, and PAUL BACON

ABSTRACT.

The diagnosis of gut vasculitis infers a poor prognosis necessitating aggressive therapy. We describe a case with predominant features of a skin-limited vasculitis but atypical debilitating abdominal symptoms. Although endoscopic biopsies were unremarkable, full thickness biopsy taken at laparotomy revealed a necrotizing vasculitis. After treatment with cyclophosphamide, the previously resistant abdominal symptoms resolved. This case illustrates the need to tailor treatment to disease severity, rather than determine it by the type of vasculitis with which the patient has been labelled. In view of the importance of gastrointestinal involvement to therapy decisions, laparotomy may be necessary to establish the presence of vasculitis. (J Rheumatol 2003;30:1621-3)

Key Indexing Terms:

VASCULITIS
PURPURA
DIAGNOSIS
LAPAROTOMY

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From the Department of Rheumatology, University Hospital Birmingham; and Department of Pathology, Birmingham Children's Hospital, Birmingham, UK.

P.A. Bacon held the Arthritis Research Campaign Chair in Rheumatology.

L.C. Willcocks, MRCP, Senior House Officer; G. Chelliah, MD, Rheumatology Specialist Registrar; P.A. Bacon, FRCP, Professor of Rheumatology, Department of Rheumatology; R.M. Brown, MRCPath, Pathology Consultant, Department of Pathology.

Address reprint requests to Dr. R.M. Brown, Department of Histopathology, Birmingham Children's Hospital, Birmingham B4 6MN, UK.

Submitted August 23, 2002; revision accepted November 28, 2002.

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