Abstract
Leukocytoclastic vasculitis (LCV) presents most commonly as palpable purpura, but
in advanced or severe cases may show ulceration. The presence of fibrinous degeneration of the vascular endothelium along with other signs of vasculitis (nuclear dust,
perivascular hemorrhage, and vascular destruction) is indicative of LCV and is often
associated with various forms of collagen vascular disease, some severe medication
reactions, and infections. Identification of this pathology is helpful in that it may
lead to proper diagnosis and therapy of the inciting cause. Leukocytoclastic vasculitis is a reaction pattern, and the many causes of the condition must be sorted
out. However, it is appreciated that true ulcerating lesions are rare in association
with self-limited post-streptococcal and infectious causes and favor systemic involvement. Thus, histology of leukocytoclastic vasculitis in the setting of ulcers requires
extensive evaluation for possible systemic involvement (Fig. 7).