Vasculitis

Question 1

temporal (giant cell)

Answer 1

large vessel vasculitis
older, female
headache, visual disturbance, Flu like symptoms, elevated ESR

biopsy: inflamed vessel wall, giant cells, intimal fibrosis

negative biopsy doesnt preclude disease

Treatment: steroids. blindness without

Question 2

takayasu

Answer 2

large vessel arteritis

granulomatous- found at aortic arch branch points

young adults, female, asian

visual/neurologic symptoms- weak distal pulses

treatment: steroids

Question 3

polyarteritis nodosa

Answer 3

medium vessel

necrotizing vasculitis in multiple organs- NO LUNGS

symptoms: hypertension (from renal artery), abdominal pain/melena (mesenteric artery), neuro, skin lesions

HBsAg

histo: transumural fibrinous necrosis- ‘string of pearls’

treatment- steroids, cyclophosphamide. fatal w/o

Question 4

kawasaki

Answer 4

medium vessel

asian kids under 4 years

symptoms: fever, conjunctivitis, rash on palms/soles, enlarged cervical lymphnodes

coronary artery involvement is common leading to thrombosis or aneurysm

treatment: aspirin, IVIG

Question 5

buerger disease

Answer 5

medium vessel

necrotizing vasculitis of digits

symptoms: ulceration/ gangrene of digits

heavy smoking- treatment is stopping

Question 6

wegener granulomatosis

Answer 6

small vessel

necrotizing granulomatous involving nasopharynx, lungs, kidneys

symptoms: middle aged male, sinusitis, nasopharyngeal ulceration, hemoptysis, nodular lung infiltrates, hematuria (glomerulonephritis)

cANCA correlates w/ disease

treatment: steroids, cyclophosphamide. common relapses

Question 7

microscopic polyangitis

Answer 7

small vessel

necrotizing vasculitis in multiple organs, especially lung and kidney- NO GRANULOMAS OR NASOPHARYNX

symptoms: middle aged male, nodular lung infiltrates and hematuria (glomerulonephritis)

pANCA correlates with disease

treatment: steroids and cyclophosphamide

Question 8

churgg strauss

Answer 8

small vessel

necrotizing granulomatous inflammation w/ eosinophils

heart and lungs

asthma and eosinophilia often present

pANCA correlates with disease

Question 9

henoch schonlein purpura

Answer 9

small vessel

children post URI

IgA complex deposition

purpura on buttocks and legs, GI bleed/pain, hematuria (IgA nephropathy)