Arteritis macular: ¿una vasculitis benigna?

Lymphocytic thrombophilic arteritis or macular arteritis presents as macular hyperpigmentation in the lower extremities and typically has a chronic indolent course. The diagnosis of this disease represents a challenge for the clinician. Histologically, it is characterized by a dense lymphocytic infiltrate around medium-sized vessels located in the reticular dermis and subcutaneous cellular tissue, together with a ring-shaped intraluminal deposit of fibrin.

Objective

Describe the clinical and histopathological characteristics of macular arteritis in order to obtain a correct diagnosis and apply appropriate treatment.

Case report

We present a 27-year-old female patient who came to the emergency room due to asymptomatic pigmented macules on the lower limbs of two months’ duration without any accompanying systemic symptoms.

Results

The skin biopsy described an inflammatory infiltrate where lymphocytes predominate around a medium-sized vessel at the dermo-hypodermis junction along with fibrinoid necrosis. After a clinical-pathological correlation, we issued the diagnosis of macular arteritis. An entity still under discussion, as there are authors who consider it part of the cutaneous polyarteritis nodosa spectrum and others who consider it a different pathology.

Conclusion

We present a young patient with macular arteritis. The infrequency of this entity gives importance to our case, expanding our knowledge regarding this vasculitis both in clinical and pathological terms.