Vasculitis

Question 1

Elderly females.

Unilateral headache/scalp tenderness, possible temporal artery tenderness,

jaw claudication.

?shoulder/pelvic girdle pain

May lead to irreversible blindness due to
Ant Isch Optic Neuropathy
-Ophthalmic artery occlusion.

Focal granulomatous inflammation, high ESR

TREATMENT????????

Answer 1

Giant cell (temporal)
arteritis

Large vessel disease

Pred 40 mg/60mg @ eye dx –> reduce dose at syx control

Bisphosphonate

Question 2

fever, night sweats, arthritis, myalgias,

“Pulse less disease” (weak upper extremity
pulses},

skin nodules

EYE/ocular disturbances.

Granulomatous thickening and narrowing of aortic arch and proximal great vessels,

Usually Asian females< 40 years old.

high ESR.

Answer 2

Takayasu PULSELESS

Large vessel disease

Question 3

URT Upper respiratory tract: perforation of nasal
septum - SADDLE,
sinusitis,
otitis media,
mastoiditis.
#Necrotizing granulomas in lung and upper
airway

LRT Lower respiratory tract:
hemoptysis, cough, dyspnea.
#Necrotizing glomerulonephritis

Renal: hematuria, red cell casts

Neuro: peripheral neuropathy (eg, wrist/foot drop) - mononeuritis multiplex

Cpr3-ANCA, CXR: large nodular densities

Answer 3

Granulomatosis with polyangiitis
(WeCener) - Cpr3-ANCA

Small-vessel vasculitis

Question 4

Asthma, sinusitis,

skin nodules or purpura,

peripheral neuropathy (eg, wrist/foot drop) - mononeuritis multiplex

?heart, GI, kidneys (pauciimmune glomerulonephritis).

Granulomatous, necrotizing vasculitis with eosinophilia,
Pmpo-ANCA, high IgE

Answer 4

Eosinophilic granulomatosis with polyangiitis (ChurgStrauss)

Pmpo-ANCA, high IgE

Small-vessel vasculitis

Question 5

URTI –> Rash palpable purpura non-blanching, Arthralgia, GI dx/intususception

Vasculitis 2° to IgA immune complex deposition.

Platelets fucking fine!!!

Answer 5

HSP

Associated with lgA nephropathy (Berger
disease FROM RENAL TOPIC!!).

Small-vessel vasculitis

Question 6

Lower respiratory tract: hemoptysis, cough,
dyspnea. #Necrotizing glomerulonephritis

Renal: hematuria, red cell casts

No upper airway/nose involvement…

No eosinophilia, normal IgE

NOOOOO granulomas

Pmpo-ANCA

Answer 6

Microscopic Polyangiitis

Small-vessel vasculitis

NOOOOO granuloma!!!

Question 7

Heavy smokers

Segmental Thrombosing vasculitis with vein and
nerve involvement

Intermittent Claudication. may lead to gangrene, autoamputation of digits,
superficial nodular phlebitis.

CorKKKK screw COLLATERALS

Young <40

Raynaud phenomenon is often present

Answer 7

Buergers

Treat with smoking cessation.

medium vessel

DIFF FROM BERGERS IGA NEPHROPATHY!!! IN RENAL TOPIC!!!

Question 8

Conjunctival injection,

Rash (polymorphous
- desquamating),

Adenopathy (cervical),

Strawberry tongue (oral mucositis)

Hand and foot changes (edema, erythema},

BURN - fever

coronary artery aneurysms, thrombosis
Asian children< 4 years old.

TREATMENT????????

Answer 8

Kawasaki - medium vessel

Aspirin and IVIG

Question 9

Fever, weight loss, malaise, headache.

neurologic dysfunction - stroke/eye dx,

Hypertension

GI: abdominal pain, melena.

Skin eruptions - livido reticularis,

Renal damage - nephritic : involves renal and visceral vessel

Hepatitis B seropositivity in 30% of patients.
Transmural inflammation of the arterial wall with fibrinoid necrosis.

Usually middle-aged men.

Answer 9

Polyarteritis nodosa

med vessels

Question 10

normal CK, HIGH ESR/CRP,

Fever, malaise, weight loss.

Pain and stiffness in proximal muscles (eg, shoulders, hips),

Does NOT cause muscular weakness

women> 50 years old;

TREATMENT????????

Answer 10

Polymyalgia rheumatica

assoc with GCA

EXCLUDE GCA -> Pred 15 mg/10mg @ DM –> reduce dose at syx control

Bisphosphonate

Question 11

Progressive symmetric prox STRIATED muscle weakness, characterized by endomysial inflammation withCD8+ T cells.

Most often involves SHOULDER. Arthralgia -
Paraeoplastic assoc

Anti Jo, high CK/aldolase
Isolated ALT/AST rise

Answer 11

Polymyositis

Anti Jo, high CK

Question 12

shawl sign macular rash,

Heliotropic rash eye puprle papular swelling

nail fold erythema - THICKENED fingertips

gottron knuckle papule

anti Mi, high CK/aldolase

Answer 12

Dermatomyositis

Question 13

Granulomatous vasculitis?

Non-Granulomatous vasculitis?

Answer 13

Large: GCA, Takayasu
Non of the medium ones!!
Small: GPA, Churg Strauss

Non-gran: Microscopic polyangiitis

Question 14

HTN @ renal crisis
Anti-Scl 70
Myositis
Bowel dx
Interstitial LUNG Dx

Cyclophos,

Answer 14

Diffuse systemic sclerosis scleroderma