Okay, so ruling certain diagnoses out isn’t entirely unhelpful, but I guess I was hoping for all of this stuff to make more sense. The dermatologist faxed us the results from my skin biopsy, and the most important fact that could be determined was that my rash is not a lupus rash. But since it’s a week and a half later and the wound still hurts from where it continues to heal below my skin, I was hoping for something more concrete than that.
Here’s the picture that came through on the faxed report; it looks like…something, doesn’t it?
![Photomicrograph that reads: Skin with inflammatory infiltrate around the superficial vascular plexus [SVP]. The infiltrate consists of lymphocytes and neutrophils. Nuclear dusts are noted. Endothelial cells are swollen. Rare eosinophils are present.](http://christinagleason.com/wp-content/uploads/2013/07/Photomicrograph.png)
The description of the photomicrograph says:
Skin with inflammatory infiltrate around the superficial vascular plexus [SVP]. The infiltrate consists of lymphocytes and neutrophils. Nuclear dusts are noted. Endothelial cells are swollen. Rare eosinophils are present.
Since I had to Google pretty much every other word in that, I’ve linked to the information I found. Although the link about SVP is still overly technical – basically it just means a place where multiple blood vessels interconnect just below the skin. In simple terms, white blood cells invaded the area around the blood vessels under my skin, and the nuclear dusts show that cell death occurred.
Pathology Consultation
They ran two separate tests, having divided the biopsied skin in half. The first results came back…
Diagnosis: Superficial Perivascular Dermatitis with Neutrophils
This is a descriptive diagnosis that means I have a rash on my skin that can be associated with blood vessel inflammation, potentially an allergic response. The report went into some more discussion:
The changes are suggestive of early urticarial vasculitis. The histological differential diagnosis could include drug eruption or arthropod bite reaction. Clinical pathologic correlation may be of help. Special staining was performed to further evaluate epidermal and dermal components as well as presence of microorganisms. A combined PAS/Alcian blue stain, ph 2.5 reveals no significant basement membrane changes, dermal mucin deposition or fungal hyphae.
Well then. If this turns out to be urticarial vasculitis, I’m not sure how early it can be. The symptoms don’t really describe my experience, and this rash is something I’ve had every day (but one) for the last 25 years. The only day I didn’t have any spots on me was when I had mono in 1999 and slept for 20 out of 24 hours. That also rules out spider bites or reaction to some form of medication, so there go the first two sentences of that part of the report. The blue stain test they did rules out fungus and a few other things.
No Immunofluorescence
The immunologic test they did showed that immunofluorescence was not observed with the following antibodies: IgG, IgM, IgA, and C3.
Frozen skin tissue was cryostat sectioned and incubated with antisera specific for IgG, IgM, IgA and C3. A routine hematoxylin and eosin stain was prepared and showed mild perivascular inflammation. Immunostaining was not observed.
They froze my skin, did stuff to it, and found no evidence of autoimmune disease – if I’m understanding this correctly. (To which I say, are you freaking kidding me?) Most specifically, it’s not lupus, because those four antibodies are most frequently found in patients with SLE. I could be wrongly generalizing this to rule out other autoimmune diseases because the skin tested was specifically part of my rash, and the rash itself is not necessarily a symptom of an autoimmune disease. But if it’s something systemic, wouldn’t it show up in my skin, too?
I see the dermatologist on Monday to get my stitches out. I see the rheumatologist the Monday after that.
Read my Big Fat Medical Update for more details.