Leukocytoclastic Vasculitis as an Initial Indicator of Prostate Cancer: A Case Report

Abstract

BACKGROUND One percent of paraneoplastic syndromes described in the literature present as cutaneous manifestations such as vasculitis, which may reveal potential initial diagnoses. Leukocytoclastic vasculitis is a subtype of small-vessel vasculitis. It affects the skin and internal organs, and diagnosis relies solely on histopathological examination. The literature on leukocytoclastic vasculitis linked with malignancies is scarce. CASE REPORT We present the case of a 60-year-old man with multiple cardiovascular comorbidities, presenting with dysuria and elevated prostate-specific antigen (PSA) levels. Further investigations led to diagnosis of metastatic prostate adenocarcinoma. Concurrently, he developed non-specific cutaneous lesions. He underwent hormonal therapy and radiotherapy. During initial treatment, the lesions rapidly progressed to necrotic ulcers; therefore, hormonal therapy was withheld. Extensive investigations ruled out potential infectious or rheumatological causes of the lesions, and histopathological analysis was consistent with cutaneous leukocytoclastic vasculitis. The patient underwent systemic corticoid treatment while continuing radiotherapy. Following completion of radiation therapy and a corticosteroid course, the patient showed good clinical response, with decreased PSA level, resolution of urological symptoms, and clinical improvement of the lesions. He was cleared for hormonal treatment continuation. CONCLUSIONS Given the temporal relationship between the onset of vasculitis, its exacerbation during first days of cancer treatment initiation and the rapid resolution following radiotherapy, a paraneoplastic etiology for leukocytoclastic vasculitis can be considered in this case. While the literature on leukocytoclastic vasculitis associated with malignancies is limited, clinicians must maintain vigilance to ensure timely and accurate diagnosis.

Figure 1.

(A) Right arm cutaneous lesion of no specific aspect. (B) Right arm lesion increased in dimension. (C) Evolution of the lesion under oncological treatment and systemic corticoid therapy. (D) Right arm residual lesion (post-inflammatory hyperpigmentation).

Figure 2.

(A) Leukocytoclastic vasculitis with secondary ulceration of the epidermis (arrows indicate the structural changes). Objective magnification hematoxylin and eosin stain (HE stain) ×20. (B) Leukocytoclastic vasculitis. Objective magnification HE stain ×40. (C, D) Leukocytoclastic vasculitis. Neutrophile migration through the microvasculature of the small dermal vessels.