April 1981

Cutaneous Vasculitis Associated With Acute and Chronic Hepatitis

Author Affiliations

From the Gastrointestinal Unit (Medical Services) (Drs Popp, Dienstag, and Wands), Department of Pathology (Drs Harrist, Bhan, and Mihm), and Dermatology (Drs Harrist and Mihm), Massachusetts General Hospital; Gastroenterology Division, Peter Bent Brigham Hospital (Dr LaMont); and Departments of Medicine (Drs Popp, Dienstag, Wands, and LaMont), Pathology (Drs Harrist, Bhan, and Mihm), and Dermatology (Drs Harrist and Mihm), Harvard Medical School, Boston.

Arch Intern Med. 1981;141(5):623-629. doi:10.1001/archinte.1981.00340050075018

• We encountered 11 patients who had rashes associated with hepatitis. Five of six acute hepatitis cases, but only one of five chronic hepatitis cases, were related to hepatitis B. Nine of the 11 patients had rash in the absence of clinically overt liver disease. Skin biopsy specimens showed histologic evidence of cutaneous vascular injury; specimens of urticarial and maculopapular rashes, which were seen in this series only with acute hepatitis, showed a primarily lymphocytic venulitis with focal necrosis, while palpable purpura, which was seen in this series only in chronic hepatitis, showed a primarily neutrophilic necrotizing vasculitis involving small vessels. One patient had lichen planus-like lesions. Demonstration of vascular deposits of immunoglobulins, complement, and fibrin in skin, as well as hypocomplementemia, circulating immune complexes, and mixed cryoglobulinemia, in these patients suggests that cutaneous lesions associated with liver disease resulted from immune complex-mediated vascular injury.

(Arch Intern Med 1981;141:623-629)