Vasculitis

Question 1

Temporal (giant cell) arteritis

Answer 1

Presentation: unilateral headache, jaw claudication
Complications: irreversible blindness due to opthalmic artery occlusion
Associated: polymyalgia rheumatica
Location: branches of carotid artery, focal ganulomatous inflammation, ESR increased
Tx: high does steroids

Question 2

Takayasu’s arteritis

Answer 2

Asian females less than 40
Presentation: pulseless disease, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances
Location: aortic arch, prox great vessels, ESR increased
Tx: steroids

Question 3

Polyarteritis nodosa

Answer 3

Young adults
Association: hep B
Sx: fever, weight loss, headache, malaise, abd pain, melena, HTN neuro, renal damage
Location: renal and visceral vessels
- immune complex mediated
- transmural inflammation of arterial wall with fibrinoid necrosis
Tx: steroids, cyclophosphamide

Question 4

kawasaki disease

Answer 4

asian children under 4
Sx: fever, cervical LAD, conjunctival injection, strawberry tongue, hand-foot erythema, desquamating rash
Location: coronary aneurysms –> MI
Tx: IV Ig and aspirin

CRASH
conjunctivitis
rash
adenopathy
strawberry tongue
hands and feet

Question 5

buerger’s disease

Answer 5

heavy smokers, males under 40
- claudication possible gangrene, nodular phlebitis, autoamp of digits, raynaud’s phenomenon
- segmental thrombosing vasculitis
Tx: smoking cessation

Question 6

microscopic polyangiitis

Answer 6

necrotizing vasculitis of lung, kidneys, skin with pauci immune GN and palpable purpura

P-ANCA
Tx: cyclophosphamide and corticosteroids

Question 7

Wegener’s granulomatosis

Answer 7

perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, hemoptysis, cough, dyspnea, hematuria, RBC casts
C-ANCA
Tx: cyclophosphamide, steroids

Triad:

• focal necrotizing vasculitis
• necrotizing granulomas in lung and upper airway
• necrotizing glomerulonephritis

Question 8

churg-strauss

Answer 8

Asthma, sinusitis, palpable purpura, peripheral neuropathy
- possible heart, GI, kidneys (pauci immune GN)
Granulomatous necrotizing vascuilits with eosinophiloia

P-ANCA, elevated IgE

Question 9

Henoch-schonlein purpura

Answer 9

Most common childhood systemic vasculitis, follows URI

Triad:

• palpable purpura on buttocks/legs
• arthralgia
• GI abdominal pain, melena, multiple lesions of same age

Secondary to IgA complex deposition

Associated: IgA nephropathy