A Case of Cutaneous Leukocytoclastic Vasculitis Presenting as the First Symptom of Adenosquamous Carcinoma of the Lung

Hyun-Ok Kim; Ho Cheol Kim; Gyung Hyuck Ko; Inseok Jang; Min Gyu Kang; Hyun Oh Park; Jian Hur; Sang-Il Lee

doi:10.4078/jkra.2010.17.3.272

Journal List > J Korean Rheum Assoc > v.17(3) > 1003737

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Kim, Kim, Ko, Jang, Kang, Park, Hur, and Lee: A Case of Cutaneous Leukocytoclastic Vasculitis Presenting as the First Symptom of Adenosquamous Carcinoma of the Lung

Original Article

J Korean Rheum Assoc 2010;17(3):272-277.

Published online: 23 September 2010

DOI: https://doi.org/10.4078/jkra.2010.17.3.272

A Case of Cutaneous Leukocytoclastic Vasculitis Presenting as the First Symptom of Adenosquamous Carcinoma of the Lung

Hyun-Ok Kim^1,⁴, Ho Cheol Kim^1,⁴, Gyung Hyuck Ko^2,⁴, Inseok Jang^3,⁴, Min Gyu Kang¹, Hyun Oh Park³, Jian Hur⁵, Sang-Il Lee^1,⁴

¹Departments of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

²Departments of Internal Pathology, Yeungnam University College of Medicine, Daegu, Korea

³Departments of Internal Pathology and Chest Surgery, Yeungnam University College of Medicine, Daegu, Korea

⁴Institute of Health Sciences, Yeungnam University College of Medicine, Daegu, Korea

⁵Gyeongsang National University School of Medicine, Jinju, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

Received 18 March 201016 April 2010 Accepted 20 April 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Leukocytoclastic vasculitis (LV) is a systemic inflammatory disorder involving the small vessels. The exact cause of LV remains unknown, yet malignancy has been considered as a causative factor for LV. We experienced a 60-year-old male with purpura on his extremities. Computed tomography of the chest showed a mass lesion that was suspected to be a non-small-cell lung cancer and the biopsy revealed an adenosquamous carcinoma. There has been no report of LV associated with adenosquamous carcinoma of the lung in Korea. Thus, we report here on this case along with a review of the relevant articles.

Keywords: Leukocytoclastic vasculitis, Lung cancer, Adenosquamous carcinoma

REFERENCES

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Fig. 1.

Purpuric lesions on the lower extremities.

Fig. 2.

(A) Chest PA shows fibrotic change with calcification in the right lung apical area and calcified pleural plaque in the left lower lung zone as the sequela of pulmonary tuberculosis. (B) Contrast enhanced CT shows about a 2 cm sized heterogeneous low attenuating mass lesion in the right lower lobe (posterior to the liver dome) (arrow).

Fig. 3.

(A) The dermal small vessels show swelling of the endothelial cells. The outline of the blood vessels appears indistinct due to the infiltration of inflammatory cells around the blood vessels (arrow). The infiltrate consists mainly of neutrophils and a small number of eosinophils and mononuclear cells. There is fragmentation of nuclei (leukocytoclasis) (dotted arrow). (B) The lung cancer shows components of both squamous cell carcinoma (arrow) and adenocarcinoma (dotted arrow) (Hematoxylin-Eosin Stain, A X 400, B X 100).

Table 1.

Cases of leukocytoclastic vasculitis with malignancy

Patient	Age/Gender	Related cancer	Systemic symptom	Laboratory finding	Imaging study	Reference
1	65/M	Lung cancer	Weakness, dyspnea	Pancytopenia	Chest CT^†	2
2	53/F	Ovarian cancer	Absent	Proteinuria, hematuria	Abdominal ultrasound	3
3	63/M	Renal cell carcinoma	Absent	Hematuria	Abdominal MRI^‡	4
4	71/M	Lung cancer	Fever	NS∗	Chest X-ray	5
5	54/M	Renal cell carcinoma	Absent	NS	Abdominal CT	6
6	60/M	Lung cancer	Arthralgia	NS	Chest CT	Present case

∗No significance, ^†Computed tomography, ^‡Magnetic resonance imaging

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