Clinical: 9 Evaluation of Vasculitides Flashcards
What are the key points of Vasculitis?
- 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
Describe Primary Vasculitis
Describe Secondary Vasculitis
Describe Small Vessel Vasculitis
- Cutaneous post-capillary venules- palpable purpura
- Glomerular capillaries- haematuria, red cell casts in urine, proteinuria, decline in renal function
- Pulmonary capillaries- lung hemorrhage
Describe Medium Vessel Vasculitis
Polyarteritis Nodosa
Kawasaki
Describe Large Vessel Vasculitis
Takayasu
Giant Cell
What are the important questions to ask yourself before a case?
Describe Secondary Vasculitis: Cryoglobulinemic vasculitis
Things to look for in DX of microscopic polyangiitis
- 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)
What are the Clinical features of Small vessel vasculiitis- microscopic polyangiitis
Skin, joints, kidneys, lungs, nerves, eyes
Blood tests: pANCA/anti-MPO
Things to look for in DX- granulomatosis with polyangiitis (wegeners)
In Small vessel vasculiitis- Granulomatosis with polyangiitis (Wegeners), what clinical features do expect to find?
How do you DX- Churg-Strauss syndrome?
What are the clinical features of Churg-Strauss syndrome?
What does this describe?
Asthma, URT, nerves, gut, heart
Histology: eosinophilic vasculitis
Blood tests: high eosinophils, ANCA+ve in <50%
Small vessel vasculiitis- Church-Strauss syndrome
Eosinophilic Granulomatosis with polyangiitis
Describe the Mononeuritis Multiplex
- ● 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
Dx this
Dx this
Dx this
What does this describe?
Pulseless disease. Med-Lg vessels, aortic arch and branches
Takayasu arteritis
- What does this describe?
- Febrile illness in children. Coronary involvement in 20% w/MI
- Acute fever with: lymphadenopathy, rash, oral/lip erythema
Kawasaki disease
What does this describe?
IgA vasculitis (henoch-schonlein)
