Histopathology of bilateral lower extremity inflammatory lymphedema in military basic trainees: A leukocytoclastic vasculitis of the deep vascular plexus

Bilateral lower extremity inflammatory lymphedema (BLEIL) is a recently described condition that presents with exquisite tenderness, erythema and edema of the lower leg, ankle and dorsal foot resembling an acute cellulitis. It was first reported in healthy, young adult military basic trainees with a...

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Bibliographic Details
Published in:Journal of cutaneous pathology 2017-05, Vol.44 (5), p.500-503
Main Authors: McCann, Shannan E., Dalton, Scott R., Kobayashi, Todd T.
Format: Article
Language:English
Subjects:
Adolescent
Ankle
Body mass
Body mass index
Cellulitis
Erythema
Erythrocytes
Extravasation
Feet
Histopathology
Humans
Immunofluorescence
Inflammation
Leg
Leukocytes (neutrophilic)
leukocytoclastic vasculitis
Lower Extremity - pathology
Lymphedema
Lymphedema - metabolism
Lymphedema - pathology
Male
military
Neutrophil Infiltration
Neutrophils - metabolism
Neutrophils - pathology
prolonged standing
trainees
Vasculitis
Vasculitis, Leukocytoclastic, Cutaneous - metabolism
Vasculitis, Leukocytoclastic, Cutaneous - pathology
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Summary:Bilateral lower extremity inflammatory lymphedema (BLEIL) is a recently described condition that presents with exquisite tenderness, erythema and edema of the lower leg, ankle and dorsal foot resembling an acute cellulitis. It was first reported in healthy, young adult military basic trainees with a normal body mass index during the first 72 hours of arrival to basic training. It occurs while standing at attention for many hours, and shows rapid resolution with elevation and rest. We report an additional case of BLEIL and describe the histopathology of this case and 2 of the previously reported cases. All 3 biopsies showed a deep perivascular infiltrate of neutrophils with karyorrhectic debris and prominent red blood cell extravasation. One of the 3 cases was positive for complement by direct immunofluorescence. We postulate this condition represents a deep leukocytoclastic vascultis with secondary reactive lymphedematous changes.
ISSN:0303-6987
1600-0560
DOI:10.1111/cup.12918