J Rheum Dis.  2015 Oct;22(5):322-326. 10.4078/jrd.2015.22.5.322.

A Case of Improved Leukocytoclastic Vasculitis after Successful Treatment of Hepatocellular Carcinoma and Membranous Obstruction of Inferior Vena Cava

• Lee JY
• Lee JW
• Lee JW
• Park HJ
• Jang GH
• Kim DJ
• Kim SM
• Han BH
• Jung GS
• Kim GT

• KMID: 2222847
• DOI: http://doi.org/10.4078/jrd.2015.22.5.322

Abstract

Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature.

Keyword

Vasculitis; Hepatocellular carcinoma; Inferior vena cava

MeSH Terms

Autoimmune Diseases
Blood Vessels
Carcinoma, Hepatocellular*
Hematologic Neoplasms
Humans
Inflammation
Polyarteritis Nodosa
Vasculitis*
Vena Cava, Inferior*

Figure

• 

  Figure 1. (A) Vascular purpura on both lower limb with the swelling of both ankle joint. (B) Inflammatory cells are predominantly infiltrated in dermal blood vessels. Epidermis is unremarkable (H&E, ×100). (C) Dermal vessels are damaged, showing swollen endothelial cells and deposition of eosinophilic fibrin within and around vascular walls. Infiltrated inflammatory cells are largely neutrophils, and associated with nuclear fragmentation (H&E, ×400).

• 

  Figure 2. (A) Axial dynamic-enhanced computed tomography (CT) scan. On an arterial-enhanced CT image, a small enhancing nodule was seen in right lobe of the liver (segment 7) measuring approximately 12 mm in diameter (arrow). (B) Inferior vena cava (IVC) gram shows short segment occlusion in intrahepatic portion of IVC (arrows) and severe distension of IVC distal to occlusive lesion (arrowheads).

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