Leukocytoclastic vasculitis in a patient with hepatitis B virus-related liver cirrhosis

Patients with chronic liver disease may exhibit cutaneous manifestations. One of these, leukocytoclastic vasculitis, is characterized histologically by damage to small cutaneous vessels and significant infiltration of neutrophils with fragmented nuclei. Recently, a 68-year-old man with hepatitis B surface antigen (HBsAg)-positive decompensated liver cirrhosis developed a typical pattern of leukocytoclastic vasculitis. Three months after the diagnosis of cirrhosis, diffuse, well-defined, matchhead- to pea-sized painful purpuric eruptions appeared on the four extremities and trunk. A skin biopsy revealed neutrophil infiltration in the upper dermis, predominantly around the blood vessels. Special stains were negative for HBsAg but positive for IgG and IgA. Circulating immune complexes were noted. These findings are consistent with leukocytoclastic vasculitis. Topical steroid was applied to the vasculitic lesion, with only limited therapeutic effect. Renal involvement was suspected because of microscopic hematuria and severely impaired renal function; however, a kidney biopsy was not performed because of the patient's tendency to bleed. The patient eventually died of hepatorenal failure.