Differential Diagnosis for Leucoclastic Vasculitis with Hypereosinophilia
Single Most Likely Diagnosis
- Churg-Strauss Syndrome: This is a form of vasculitis that is characterized by the presence of asthma, high levels of eosinophils (hypereosinophilia), and vasculitis affecting multiple organ systems. The combination of leucoclastic vasculitis (a type of small vessel vasculitis) and hypereosinophilia makes Churg-Strauss Syndrome a strong candidate for the single most likely diagnosis.
Other Likely Diagnoses
- Polyarteritis Nodosa (PAN): While PAN typically does not present with hypereosinophilia, some variants can. It's a medium and small artery vasculitis that can present with skin manifestations, including leucoclastic vasculitis.
- Eosinophilic Granulomatosis with Polyangiitis (EGPA): Similar to Churg-Strauss Syndrome, EGPA is characterized by asthma, eosinophilia, and vasculitis, but it tends to have a more gradual onset and may involve granulomatous inflammation.
- Hypereosinophilic Syndrome (HES): This condition is characterized by persistent and marked eosinophilia that can lead to organ damage, including the skin. While not primarily a vasculitis, the skin manifestations can mimic leucoclastic vasculitis.
Do Not Miss Diagnoses
- Infectious Causes: Certain infections (e.g., bacterial, fungal, or parasitic) can cause both vasculitis and eosinophilia. Missing an infectious cause could lead to inappropriate treatment and potentially fatal outcomes.
- Malignancy: Some malignancies, particularly hematologic ones like lymphoma or leukemia, can present with vasculitis and eosinophilia. Failing to consider and diagnose a malignancy could have severe consequences.
- Drug-Induced Vasculitis: Various drugs can induce vasculitis and eosinophilia. Identifying and stopping the offending drug is crucial for treatment and prevention of further complications.
Rare Diagnoses
- Eosinophilic Fasciitis: A rare condition characterized by eosinophilia and inflammation of the fascia, which could potentially mimic some features of leucoclastic vasculitis.
- Loeffler's Syndrome: A rare condition involving pulmonary eosinophilia, which could be part of a broader syndrome including skin manifestations.
- Kimura Disease: A rare, chronic inflammatory disorder that can present with eosinophilia and lymphadenopathy, and occasionally skin lesions that might resemble vasculitis.