Dr Ali Alkazzaz
Babylon collage of medicine
group of clinical syndromes characterized by
inflammation
of blood vessels
VASCULITIS
systemic diseases can affect many different organ
systems
difficult to diagnose: challenging clinical picture even
for experienced clinicians
can be life-threatening
classification
Approach to Vasculitis
General Approach to Vasculitis
When should vasculitis be
suspected
MULTISYSTEM inflammatory disease
Significant CONSTITUTIONAL SYMPTOMS
RAPIDLY PROGRESSIVE organ dysfunction
HIGH ESR
SEVERE anemia
PLATELETS > 500K
CLINICAL FEATURES PARTICULARLY
SUGGESTIVE of small vessel inflammation:
SKIN: palpable purpura *
LUNGS: pulmonary infiltrates /
hemoptysis
KIDNEY: active urinary sediment
NEURO: foot drop
General Approach to Vasculitis
Gather your
equipment….
Find the target….
Take aim…..
NAIL IT !
Early diagnosis
HISTORY:
PATIENT’S STORY
get careful CHRONOLOGY
…….PROBLEMS
PHYSICAL EXAM:
BODY’S STORY
thoughtful, thorough
……..MORE PROBLEMS
LABORATORY:
BEHIND-THE-SCENES STORY
Basic CBC, CHEMS, LFTs, UA/micro, CXR
……..MORE PROBLEMS
SYSTEMIC VASCULITIS ?
Are there additional tests which could help confirm
this suspicion?
Serologic tests
Imaging studies
Tissue biopsy
Serologic tests
ANCA
Hepatitis B surface antigen
Hepatitis C, C3 & C4
HIV
ANA
ACA, “lupus” anticoag panel
VASCULITIS: additional
testing
Imaging studies
Sinus CT scan
Chest CT scan
Mesenteric
angiogram
Git vasculitis
Wergner
granuloma
Poly angitis
VASCULITIS: additional
testing
Tissue biopsy
Temporal artery
Sural nerve
Muscle
Lung
Renal
Clinical Manifestations
Respiratory
Sinusitis / Epistaxis
Pulmonary infiltrates
Gastrointestinal
Abdominal Pain
Bloody stools
Renal
Glomerulonephritis
Hypertension
Systemic
Fever, sweats,
weight loss
Skin
Palpable Purpura
Neurologic
Mononeuritis Multiplex
Musculoskeletal
Arthralgia / arthritis
Muscle pain / claudication
CUTANEOUS
Palpable Purpura
Livedo Reticularis
Splinter Hemorrhages
NEUROLOGIC
Mononeuritis multiplex:
FOOT DROP
Sural nerve biopsy showing vasculitis
RESPIRATORY: upper
Sinusitis
Or……
RESPIRATORY: lower
Pulmonary infiltrates
Nodules
Cavities
GENITOURINARY
Glomerulonephritis
Hypertension
Hematuria
RBC casts
Testicular pain
(especially PAN
MUSCULOSKELETAL
Polyarthralgias - common
Polyarthritis - less common
Myalgias - common
Myositis - biopsy may demonstrate
vasculitis in muscle
GASTROINTESTINAL
Mesenteric ischemia
pain 30 minutes
after eating
bloody diarrhea
bowel perforation
hepatitis
pancreatitis
cholecystiti
s
OCULAR
Scleritis
eyelearn.med.utoronto.ca/.../RedE
ye/10Sclera.htm
http://www.uveitis.org/imag
es/sarcoid6.jpg
Retinal Vasculitis
http://webmedia.unmc.edu/eye/iritis.jpg
Iritis
Common Laboratory Findings
INFLAMMATION:
Elevated ESR (can be > 100)
Elevated CRP
Leukocytosis
Thrombocytosis
Anemia
Low Albumin
VASCULITIS MIMICS
INFECTIOUS DISEASES
Endocarditis
HIV
DRUGS
Cocaine
Methamphetamine
CHOLESTEROL EMBOLI
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
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