Clinical: 9 Evaluation of Vasculitides

Question 1

What are the key points of Vasculitis?

Answer 1

• Damage to vessels
• Every organ system ‘syndrome’ can be involved, or single organ
• ‘Polyangiitis’ usually denotes small vessel
• Rare (delays dx)
• Primary or secondary to another disease
• Presentation: varies from minimal to life-threatening

Question 2

Describe Primary Vasculitis

Answer 2

Question 3

Describe Secondary Vasculitis

Answer 3

Question 4

Describe Small Vessel Vasculitis

Answer 4

• Cutaneous post-capillary venules- palpable purpura
• Glomerular capillaries- haematuria, red cell casts in urine, proteinuria, decline in renal function
• Pulmonary capillaries- lung hemorrhage

Question 5

Describe Medium Vessel Vasculitis

Answer 5

Polyarteritis Nodosa

Kawasaki

Question 6

Describe Large Vessel Vasculitis

Answer 6

Takayasu

Giant Cell

Question 7

What are the important questions to ask yourself before a case?

Answer 7

Question 8

Describe Secondary Vasculitis: Cryoglobulinemic vasculitis

Answer 8

Question 9

Things to look for in DX of microscopic polyangiitis

Answer 9

• protein in urine
• normal kidneys
• Renal biopsy: “crescentic glomerulonephritis”
• P Anti-neutrophil cytoplasmic antibody positive (Anti-MPO titre 504)
• ANCA associated vasculitis–microscopic polyangiitis (MPA)

Question 10

What are the Clinical features of Small vessel vasculiitis- microscopic polyangiitis

Answer 10

Skin, joints, kidneys, lungs, nerves, eyes

Blood tests: pANCA/anti-MPO

Question 11

Things to look for in DX- granulomatosis with polyangiitis (wegeners)

Answer 11

Question 12

In Small vessel vasculiitis- Granulomatosis with polyangiitis (Wegeners), what clinical features do expect to find?

Answer 12

Question 13

How do you DX- Churg-Strauss syndrome?

Answer 13

Question 14

What are the clinical features of Churg-Strauss syndrome?

Answer 14

Question 15

What does this describe?

Asthma, URT, nerves, gut, heart
Histology: eosinophilic vasculitis
Blood tests: high eosinophils, ANCA+ve in <50%

Answer 15

Small vessel vasculiitis- Church-Strauss syndrome
Eosinophilic Granulomatosis with polyangiitis

Question 16

Describe the Mononeuritis Multiplex

Answer 16

• ● Mononeuritis multiplex
  
  • ○ Peripheral neuropathy–asymmetric or symmetric ○ Seen in up to 45% of patients with EGPA (Churg-Strauss)
  • Causes
    
    • ■ Leprosy (most common)
    • ■ DM
    • ■ Vasculitis
    • ■ Sarcoidosis
    • ■ Amyloidosis
    • ■ Malignancy
    • ■ Neurofibromatosis
    • ■ HIV infection
    • ■ Idiopathic multifocal motor neuropathy

Question 17

Dx this

Answer 17

Question 18

Dx this

Answer 18

Question 19

Dx this

Answer 19

Question 20

What does this describe?

Pulseless disease. Med-Lg vessels, aortic arch and branches

Answer 20

Takayasu arteritis

Question 21

• What does this describe?​
  
  • Febrile illness in children. Coronary involvement in 20% w/MI
  • Acute fever with: lymphadenopathy, rash, oral/lip erythema

Answer 21

Kawasaki disease

Question 22

What does this describe?​

Answer 22

IgA vasculitis (henoch-schonlein)