Cutaneous leukocytoclastic vasculitis with positive anti-neutrophil cytoplasmic antibodies.

Sir, Anti-neutrophil cytoplasmic antibodies (ANCA) are useful diagnostic serological markers for systemic vasculitides. W|th indirect immuno£uorescence, two distinct patterns are seen: a coarse granular, centrally accentuated cytoplasmic staining (c-ANCA) and a perinuclear staining (p-ANCA) on ethanol¢xed neutrophil cytocentrifuge preparations (1). c-ANCA is considered highly speci¢c for Wegener's granulomatosis (WG) (2). Changes in titre often re£ect changes in the disease activity. WG directly a¡ects the skin in about 14% of patients (3). Purpura and petechiae on the lower extremities are the most common manifestations. These tend to occur early in the course of the disease and are frequently presenting signs. Histologically, leukocytoclastic vasculitis (LCV) is the most common pattern (3 ^ 5). We report here a patient who presented with LCV on the lower extremities and positive cANCA results, but with no evidence of systemic vasculitis. After 4 years of recurrent episodes of purpura, classic pulmonary WG developed.