Which physical findings are characteristic of leukocytoclastic reactions in patients with hepatitis C (Hep C)?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Some leukocytoclastic reactions may occur, described as follows:

  • Palpable purpura is the classic presentation of mixed cryoglobulinemia as leukocytoclastic inflammatory reactions in the skin.

  • Type III cryoglobulinemia results when no specific antigenicity of the immune reactants is identifiable. In this case, HCV may serve as one of the antigens. In chronic hepatitis C infection, 50% of patients have identifiable cryoglobulin levels.

  • Type II cryoglobulinemia was present in two thirds of patients with IgM rheumatoid factor. Clinicians can identify the lesions by their purpuric and elevated nature and red or purple spots on the lower legs. Specific identification is by skin biopsy. The lesions result in ulcerations of various sizes and depths because the small venules and arterioles are obstructed, damaged, or ruptured by the inflammation generated by sludging of viscous immune reactants. Polyfunctional rheumatoid factor, usually IgM, attaches to available IgG molecules, forming enormous molecules that congeal and clog small vessels and vasa vasorum of the skin and joints. Associated neutrophilic inflammatory infiltrate leads to vascular injury and ulcerations of the lower leg, which are often exquisitely painful.

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