Vasculitis EC

Question 1

What are the key findings in small vessel vasculitis?

Answer 1

Palpable purpura (due to acute inflammation)

Question 2

What are the key findings in medium vessel vasculitis?

Answer 2

Thrombosis

Aneurisms

Question 3

What are the key findings in large vessel vasculitis?

Answer 3

Absent pulse

Stroke

Question 4

Elderly female with unilateral headache and jaw claudication. Ipsilateral blindness due to ophthalmic artery vasculitis. Polymyalgia rheumatica. (Disease, Findings, and Treatment)

Answer 4

Temporal (giant cell) arteritis

Granulomatous large vessel vasculitis involving superficial temporal and ophthalmic arteries

Increased ESR

Treat with corticosteroids

Question 5

Young asian woman w/ absent upper extremity pulse. >10mmHg discrepancy in blood pressure between arms. Visual defects, and stroke. (Disease, Findings, Treatment)

Answer 5

Takayasu arteritis

Granulomatous large vessel vasculitis involving aortic arch vessels

Increased ESR

Treat with corticosteroids

Question 6

Young adult with hep B w/ fever, weight loss, malaise, and headache, abdominal pain, melena, hypertension, neurologic dysfunction, cutaneous eruptions, and renal damage (disease, findings, treatment)

Answer 6

Polyarteritis nodosa

Necrotizing medium sized vasculitis involving renal, coronary, and mesenteric arteries
Immune-complex mediated
Lesions are of different stages
Many aneurysms and constrictions on arteriogram

Treat w/ corticosteroids or cyclophosphamide

Question 7

Young asian child w/ fever, erythema and edema of hands and feet convalescing with desquamated rashl cervical adenopathy, oral erythema and cracking of the lips; “strawberry tongue”. Acute MI. (disease, findings, treatment)

Answer 7

Kawasaki disease

Necrotizing medium-sized vessel vasculitis involving coronary arteries

Treat w/ IVIG, aspirin, corticosteroids only if IVIG unsuccessful

Question 8

Male who is a heavy smoker with intermittent claudication that leads to gangrene, amputation of digits, superficial nodular phlebitis and Raynaud’s phenomenon. (Disease, Findings, Treatment)

Answer 8

Thromboangiitis obliterans (Buerger disease)

Medium sized vessel vasculitis w/ digital vessel thrombosis and damage to neurovascular compartment
Always in lower extremity, often in upper

Treat w/ smoking cessation

Question 9

Young woman with paroxysmal digital color changes in digits; ulceration and gangrene in chronic cases. (disease, findings, treatment)

Answer 9

Raynaud disease (Raynaud phenomenon when due to SLE or CREST)

Medium sized vessel vasculitis involving digital vessels in fingers and toes

Treat by avoiding cold temperatures (wearing gloves) and Ca channel blockers

Question 10

Necrotizing vasculitis of lung, kidneys, and skin. Palpable purpura, glomerulonephritis (pauci-immune, crescentic), vessels at same stage of inflammation, p-ANCA antibodies. (Disease, Findings, Treatment)

Answer 10

Microscopic polyangiitis

Treat with corticosteroids and cyclophosphamide

Question 11

Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, hemoptysis, cough, dyspnea, hematuria, red cell casts. (Disease, Findings, Treatment)

Answer 11

Granulomatosis w/ polyangiitis (Wegener’s)

Focal necrotizing vasculitis
Necrotizing granulomas in lung/upper airway
Necrotizing glomerulonephritis
c-ANCA

Treat w/ cyclophosphamide and corticosteroids

Question 12

Asthma, sinusitis, palpable purpura, peripheral neuropathy. Can also involve heart, GI, kidneys (pauci-immune glomerulonephritis) (disease, findings)

Answer 12

Churge-Strauss syndrome

Granulomatous necrotizing vasculitis with eosinophilia
p-ANCA
Elevated IgE

Question 13

Child w/ Palpable purpura on buttocks/legs, Arthralgia, Abdominal pain, melena, multiple lesions of same age. Often follows URI (disease, findings)

Answer 13

Henoch-Schonlein purpura

Vasculitis secondary to IgA complex deposition
Associated with IgA nephropathy