Vasculitis Flashcards
Two types of symptoms with vasculitis?
- Non-specific systemic symptoms
* Symptoms of organ ischemia
Large vessel vasculitis involves what
Aorta and major branches
Two main types of large vessel vasculitis
Temporal (giant cell) arteritis
Most common vasculitis in adults?
Temporal arteritis
Temporal arteritis most commonly affects what?
Branches off the carotid artery
Symptoms of temporal arteritis?
- HA
- Visual disturbances
- Jaw claudication
Common lab finding in ESR
Very high ESR > 100
What are two ways that you can get ischemia secondary to vasculitis?
- Disrupt the endothelium → coagulation → thrombus
2. Injure wall → heal wall → fibrosis and narrowing
What will biopsy of temporal cell arteritis show?
Granulomatous inflammation (which shows giant cells) and intimal fibrosis (healing response)
What is the distribution of inflammation in giant cell arteritis?
It is segmental
How does Takayasu’s compare to giant cell arteritis?
Its almost the same except:
• Adults < 50 y/o (young Asian female)
• More proximal (aortic arch at branch points)
• Weak or absent pulses in upper extremity
• (will have elevated ESR and treat with steroids)
What arteries are involved in medium vessel vasculitis?
Muscular arteries supplying organs
What is polyarteritis nodosa?
A NECROTIZING vasculitis that involved MOST organs but spares the LUNGS
Symptoms of polyarteritis nodosa?
- HTN (renal arteries)
- Abdominal pain with melena (mesenteric artery)
- Neurological distrubances
- Skin lesions
- Associated with serum HBsAG
What type of necrosis is involved with polyarteritis nodosa?
Transmural fibrinoid necrosis
What is the common radiological finding in polyarteritis nodosa?
String of pearls appearance due to alternating segments of early fibrinoid necrosis and areas of fibrosis
What disease commonly affects Asian children less than 4 years of age?
Kawasakis
What are early symptoms of Kawasaki’s disease?
Vague symptoms: • Fever • Conjunctivitis • Erythematous rash on palms and soles • Enlarged cervical lymph nodes
What artery is preferentially involved with Kawasaki’s?
Coronary artery (can lead to MI or aneurysm
What is Buerger disease?
Medium vasculitis involving the arteries of the hands which will present with ulceration, gangrene, and autoamputation of the hands.
What is the treatment for Buerger disease
Stop smoking
What is Wegener’s granulomatosis?
Necrotizing granulomatous vasculitis of the nasopharynx, lungs, and kidneys
Treatment for Wegeners
Cyclophosphamide
High risk population for Wegeners
Middle aged male
Kidney involvement with Wegeners
Rapidly progressive glomerulonephritis
Serology for Wegeners
Elevated C-ANCA
What is microscopic polyangiitis?
Like Wegners but without nasopharyngeal involvement or granulomas
Serology for Microscopic polyangiitis?
Elevated P-ANCA
What is Churg-Strauss syndrome?
Necrotizing granulomatous vasculitis with eospinophilia which involved multiple organs including lungs and heart (differentiate this from microscopic polyangiitis)
How can you differentiate Churg-Strauss from microscopic polyangiitis since they both have p-anca
- Not granulomas with microscopic polyangiitis
* Churg-Strauss typically has asthma and eosinophilia
What is HSP?
Vasculitis from IgA and ICs deposition
What is most common vasculitis in kids?
HSP
What is rash like in HSP?
Palpable purpura in buttocks and legs
What are non-skin findings in HSP?
- Hematuria from IgA nephropathy
* GI pain and bleeding
When does HSP usually occur?
After a URI type infection (because you will get IgA production during URIs)
What is treatment for HSP?
Generally self-limited but can treat with steroids
