Histopathology - Vasculitides

Question 1

What are the large vessel vasculitides?

Answer 1

• Takayasu’s arteritis
• Temporal arteritis

Question 2

What are some general features of Takayasu’s arteritis?

Answer 2

• Affects branches of aortic arch
• Inflammatory phase = FLAWS
• Pulseless phase = “pulseless” claudication, cold hands
• Increased prevalence in japanese women

Question 3

What are some general featuers of Temporal arteritis?

Answer 3

• Elderly (>50)
• Scalp tenderness + temporal headache + jaw claudication + blurred vision + non-palpable temporal pulse
• Increased ESR
• Overlap with polymyalgia rheumatica
• Ix: ESR (first) + temporal artery biopsy (definitive)
• Tx: Oral prednisolone (Immediate)

Question 4

What are the medium vessel vasculitides?

Answer 4

• Polyarteritis Nodosa
• Buerger’s disease

Question 5

What are some general features of Polyarteritis Nodosa?

Answer 5

• Renal involvement = main feature
• Can have other organ involvement, but lung-sparing
• 30% have underlying Hep B
• Microaneurysms on angiography (string of pearls, rosary bead appearance)
• Histo: Fibrinoid necrosis + neutrophil infiltration

Question 6

What are some general features of Buerger’s disease?

Answer 6

• Heave smokers
• Men <35yrs
• Inflammation of arteries of extremities (usually tibial + radial)
• Pain + ulceration of toes, feet + fingers
• Angiogram: CORKSCREW APPEARANCE from segmented occlusive lesions

Question 7

What are the small vessel vasculitides?

Answer 7

• Granulomatosis with Polyangiitis (Wegener’s)
• Eosinophilic granulomatosis with polyangiitis
• Microscopic polyangitis
• Henoch-Schonlein Purpura

Question 8

What is the triad for Granulomatosis with Polyangiitis?

Answer 8

• Upper Respiratory Tract: Sinusitis, Epistaxis, SADDLE NOSE
• Lower Respiratory Tract: Cavitation, PULMONARY HAEMORRHAGE
• Kidneys: Crescenteric GLOMERULONEPHRITIS (causes haematuria + proteinuria)

Question 9

What autoantibody is present in Granulomatosis with Polyangiitis?

Answer 9

• cANCA

Question 10

What are the general features of Eosinophilic granulomatosis with polyangiitis?

Answer 10

• ASTHMA
• Allergic rhinitis
• Eosinophilia
• Later systemic involvement

Question 11

Which autoantibody is present in Granulomatosis with Polyangiitis?

Answer 11

• pANCA

Question 12

What are the general features of Microscopic polyangitis?

Answer 12

• PULMONARY RENAL syndrome:
• Pulmonary haemorrhage
• Rapidly progressive glomerulonephritis

Question 13

Which autoantibody is present in Microscopic polyangitis?

Answer 13

pANCA

Question 14

What are the general features of Henoch-Schonlein Purpura?

Answer 14

• IgA mediated vasculitis
• Children 3-15yrs
• Preceding URTI –> Glomerulonephritis

Triad:
- Purpuric rash on lower limb extensors + buttocks
- Abdo pain
- Arthralgia