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Leucocytoclastic vasculitic neuropathy diagnosed by biopsy of normal appearing skin
  1. Y Yamanaka1,
  2. A Hiraga1,
  3. K Arai1,
  4. M Mori1,
  5. K Kanai1,
  6. T Hattori1,
  7. S Kuwabara1,
  8. T Oide2,
  9. T Tanizawa2
  1. 1Department of Neurology, Chiba University School of Medicine, Chiba, Japan
  2. 2Department of Pathology, Chiba University Hospital
  1. Correspondence to:
 Dr Satoshi Kuwabara
 Department of Neurology (D3), Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; kuwabara-s{at}faculty.chiba-u.jp

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Leucocytoclastic vasculitis (LCV) is a clinicopathological entity that preferentially involves capillaries or small vessels rather than the medium sized or large arteries typical of polyarteritis nodosa. Its histopathological features are characterised by the presence of perivascular polymorphonuclear leucocytes with fragmented nuclear debris (leucocytoclasis).1 It may be limited to skin lesions such as erythematous macules, purpuric papules, and haemorrhagic vesiculobullous lesions. Although LCV often involves organ systems other than the skin, it is rarely associated with neurological complications, unlike polyarteritis nodosa or Churg-Strauss syndrome. We report a patient who presented with leucocytoclastic vasculitic neuropathy without skin lesions, and discuss the value of doing a combined biopsy of the skin, nerves, and muscle in this patient for the detection of vasculitis.

A 44 year old man was admitted to our hospital because of progressive asymmetrical paraesthesiae in all four limbs. Eight months before admission, a tingling sensation had begun in the second finger of his left hand, but it disappeared spontaneously within one month. Over the next seven months, he experienced dysaesthesia which spread gradually on the lateral sides of his feet, and later to his left hand, and he developed drop foot on the right. Two weeks before admission, he had dysaesthesia in his right hand and …

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