Henoch-Schönlein purpura: clinicopathologic correlation of cutaneous vascular IgA deposits and the relationship to leukocytoclastic vasculitis

Acta Derm Venereol. 1995 Mar;75(2):125-9. doi: 10.2340/0001555575125129.

Abstract

Significant cutaneous vascular IgA deposits are common in Henoch-Schönlein purpura but not in other vasculitides. The specificity for IgA vascular deposits for Henoch-Schönlein purpura is not well defined. To examine the specificity of IgA vascular deposits for this disease, we compared clinicopathologic features of 92 cases with IgA vascular deposits and a direct immunofluorescence impression of vasculitis with 90 similar cases without IgA deposits. Henoch-Schönlein purpura was diagnosed in 24% of cases with vascular IgA deposits on direct immunofluorescence examination. IgA deposits were frequent in erythema nodosum and venous stasis-related problems and in cryoglobulinemia, coagulopathic vasculopathies, and livedoid vasculitis. Of our cases, 78% exhibited vascular fluorescence with multiple conjugates. No histologic or immunofluorescence pattern alone was specific. The diagnostic specificity for Henoch-Schönlein purpura is improved if gastrointestinal involvement, upper respiratory infection, or age < 20 years is present. We propose diagnostic criteria for Henoch-Schönlein purpura incorporating clinical findings yielding sensitivity and specificity > 90%.

MeSH terms

  • Biopsy
  • Fluorescent Antibody Technique
  • Humans
  • IgA Vasculitis / immunology*
  • IgA Vasculitis / pathology*
  • IgA Vasculitis / physiopathology
  • Immunoglobulin A / analysis*
  • Sensitivity and Specificity
  • Vasculitis, Leukocytoclastic, Cutaneous / immunology*
  • Vasculitis, Leukocytoclastic, Cutaneous / pathology*
  • Vasculitis, Leukocytoclastic, Cutaneous / physiopathology

Substances

  • Immunoglobulin A