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Case Reports
. 2021 Mar-Apr;96(2):240-242.
doi: 10.1016/j.abd.2020.06.009. Epub 2021 Jan 30.

Case for diagnosis. Cutaneous small vessel vasculitis (anti-proteinase 3 positive), fever, hemoptysis, and lung cavitation in an adult

Luana Moraes Campos  1 , Mariana Righetto de Ré  1 , Priscila Neri Lacerda  1 , Hélio Amante Miot  2
Affiliations
Case Reports

Case for diagnosis. Cutaneous small vessel vasculitis (anti-proteinase 3 positive), fever, hemoptysis, and lung cavitation in an adult

Luana Moraes Campos et al. An Bras Dermatol. 2021 Mar-Apr.

Abstract

Small vessel vasculitis with anti-proteinase antibodies 3 is an atypical clinical presentation of tuberculosis. The authors present the case of a 47-year-old male patient, with palpable purpura and palmoplantar hemorrhagic blisters, with subsequent dissemination. He presented severe pulmonary symptoms with cavitation, fever, hemoptysis, and high levels of anti-proteinase 3. Histopathological assessment of the skin revealed small vessel vasculitis; pulmonary histopathology showed granulomas with caseation. Bronchoalveolar lavage was positive for alcohol-acid-fast bacilli. In countries with a high prevalence of tuberculosis, the presence of autoantibodies in a patient with vasculitis, fever, and pulmonary cavitation requires investigation of infectious causes.

Keywords: Anti-neutrophil cytoplasmic antibodies; Anti-neutrophil cytoplasmic antibody-associated vasculitis; Tuberculosis; Vasculitis.

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Figures

Figure 1
Figure 1
Multiple, bilateral palpable petechiae and purpura on the soles.
Figure 2
Figure 2
Palpable purpura and necrotic vesicles on the left lower limb.
Figure 3
Figure 3
Computed tomography scan of the chest showing cavitation with a thick wall in the right upper lobe amid consolidations in other pulmonary areas.
Figure 4
Figure 4
Histopathological examination of the skin showing intense diffuse inflammatory infiltrate in the dermis, red blood cells leakage, vascular walls infiltrated by neutrophils, and fibrinoid necrosis. Subepidermal vesicle, filled with red blood cells and neutrophils (Hematoxylin & eosin, ×10).
See this image and copyright information in PMC

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