B6-035 Henock-Shoenlein Purpura

Question 1

small vessel vasculitis preceded by viral respiratory infection

Answer 1

Henoch-Shonlein purpura (IgA vasculitis)

Question 2

IgA dominant immune deposits

Answer 2

Henoch-Shonlein purpura (IgA vasculitis)

Question 3

Henoch-Shonlein purpura (IgA vasculitis) must have palpable purpura without […]

Answer 3

thrombocytopenia

Question 4

where on the body does Henoch-Shonlein purpura (IgA vasculitis) concentrate? [2]

Answer 4

legs
buttocks

Question 5

what kinds of GI involvement can Henoch-Shonlein purpura (IgA vasculitis) present with?

Answer 5

-abdominal pain
-melena or bloody stools
-intussusception

Question 6

Kidney involvement of Henoch-Shonlein purpura (IgA vasculitis) is identified with […] or […] on urinalysis

Answer 6

blood
protein

Question 7

treatment for Henoch-Shonlein purpura (IgA vasculitis)

Answer 7

symptom control - analgesia
pulse dose IV methylprednisone followed by PO steroids with long taper
serial monitoring of kidney function

Question 8

small vessel vasculitis affecting primarily the glomerular and pulmonary capillaries

Answer 8

anti-GBM (Goodpasture)

Question 9

anti-GBM (Goodpasture) is characterized by antibodies directed against

Answer 9

basement membrane

Question 10

80-90% of patients present with glomerulonephritis
50% present with lung hemorrhage

Answer 10

anti-GBM (Goodpasture)

type 2 HS

Question 11

linear deposits of IgG along the GBM

Answer 11

anti-GBM (Goodpasture)

Question 12

significant crescent formation on histopathology of the kidney

Answer 12

anti-GBM (Goodpasture)

**HSP has some, but not nearly as significant

Question 13

treatment for anti-GBM (Goodpasture)

Answer 13

plasmapheresis
corticosteroids (much longer treatment time than HSP)

type 2 HS

Question 14

type III hypersensitivity where protein antigens from the drug binds antibody

Answer 14

drug induced vasculitis

Question 15

biopsy of skin rash shows neutrophils around small vessel

Answer 15

drug induced vasculitis

Question 16

high ESR
low C3/C4
normal urinalysis

Answer 16

drug induced vasculitis

Question 17

treatment for drug induced vasculitis

Answer 17

stop drug, replace as applicable

Question 18

most common initial symptom of IgA vasculitis

Answer 18

skin findings

Question 19

most helpful initial test in evaluation of HSP

Answer 19

CBC

**to evaluate thrombocytopenia

Question 20

biggest concern of HSP is developing […] involvment

Answer 20

kidney

Question 21

poor prognostic indicators of HSP [3]

Answer 21

older patient
hypertension
crescents

Question 22

treatment of choice for HSP

Answer 22

high dose pulse methylprednisone followed by long taper

Question 23

treatment of choice for drug induced vaculitis

Answer 23

stop offending agent
replace with different class as needed

Question 24

typical symptoms of HSP [3]

Answer 24

skin rash
arthritis
hematuria

Question 25

HSP patients most commonly experience arthritis in the

Answer 25

ankles

can be migratory

Question 26

most likely chronic symptom of HSP

Answer 26

kidney involvement

Question 27

1/3 of HSP patients experience

Answer 27

relapse

**usually only involving skin

Question 28

without treatment, HSP patients will

Answer 28

spontaneously recover in 4-6 weeks

**corticosteroids improve symptoms sooner

Question 29

what is the pathological mechanism of HSP?

Answer 29

IgA immune complexes cause a complement and Fc receptor mediated activation of inflammatory cells

Question 30

HSP is mediated by […] immune complexes

Answer 30

IgA

type 3 HS

Question 31

[…] MUST be excluded prior to diagnosis of HSP

Answer 31

thrombocytopenia

Question 32

does relapse occur in drug induced vasculitis?

Answer 32

no, only with re-exposure

Question 33

most patients with drug induced vasculitis have full resolution of symptoms within

Answer 33

1-2 weeks

Question 34

are steroids used to treat drug induced vasculitis?

Answer 34

no