idiopathic but may occasionaly occur in hepatitis, HIV or haematological malignancy (1)
other possible associations include (2) previous infection particularly by streptococcus or it can be a manifestation of occult neoplasia, including myeloma, myelodysplasia, or acute myelogenous leukaemia, and nonneoplastic disorders such as inflammatory bowel disease, relapsing polychondritis, and rheumatoid arthritis
there is no association with systemic vasculitis, and autoantibodies are not usually detected
red-purple plaques occur on the back of hands and joints; these plaques gradually harden and become yellow-brown
histology - leukocytoclasis with fibrosis and granuloma formation
even when the clinical course is chronic, the histological picture is acute (2) Microscopic features include angiocentric neutrophils with some leucocytoclasis, but fibrin is scanty
infiltrate is often mixed with some lipid-containing histiocytes
laminated angiocentric fibrosis again may be present.
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