My watch list
my.bionity.com  
Login  

Hypersensitivity vasculitis



Hypersensitivity vasculitis
Classification & external resources
ICD-10 M31.0
ICD-9 446.2
DiseasesDB 7423
eMedicine med/2930 
MeSH C14.907.940.910

Hypersensitivity vasculitis (or hypersensitivity angiitis or leukocytoclastic vasculitis) is usually due to a hypersensitivity reaction to a known drug, auto-antigens or infectious agents such as bacteria. Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes who in turn release tissue-degrading substances leading to an inflammatory process.

Additional recommended knowledge

Contents

Clinical Presentation

Palpable, normally painful, petechiae or purpura (skin vasculitis). The lesions normally arise in crops, with common localizations being the forearms and legs. Necrosis of skin tissue can yield lesions with black or brown centres. This disorder may affect the skin only, but sometimes affect nerves, the kidneys, joints and the heart. Renal involvement is common.

Investigations

The primary goal is to identify the causing agent, be it a drug or a microbe. Questioning is important, as is a thorough physical examination, chest X-ray, ESR and biochemical organ tests. Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules. Tests for hepatitis virus, antinuclear antibodies, rheumatoid factor and cryoglobulins might be indicated.

Diagnostic Criteria

An important differential is Henoch-Schönlein purpura. [1]

At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:

  • Age > 16.
  • Use of possible triggering drug in relation to symptoms.
  • Palpable painful purpura (the three P's).
  • Maculopapular rash.
  • Skin biopsy showing neutrophil infiltration around vessel.

Treatment

The most important part of the treatment is to eliminate the cause of the vasculitis, if at all possible. Antihistamines prove helpful to some patients. If the vasculitis is damaging organ systems such as the kidneys, immunosuppressive agents are indicated.

See also

References

  1. ^ Michel BA, Hunder GG, Bloch DA, Calabrese LH (1992). "Hypersensitivity vasculitis and Henoch-Schönlein purpura: a comparison between the 2 disorders". J. Rheumatol. 19 (5): 721–8. PMID 1613701.

acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula)

patella (Luxating patella, Chondromalacia patellae)

Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte
Systemic connective
tissue
disorders
Polyarteritis nodosa - Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Goodpasture's syndrome - Wegener's granulomatosis - Arteritis (Takayasu's arteritis, Temporal arteritis) - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility
DorsopathiesKyphosis - Lordosis - Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis - Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Neck pain, Sciatica, Low back pain)
Soft tissue disordersmuscle: Myositis - Myositis ossificans (Fibrodysplasia ossificans progressiva)

synovium and tendon: Synovitis - Tenosynovitis (Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome)

bursitis (Olecranon, Prepatellar, Trochanteric)

fibroblastic (Dupuytren's contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis)

enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer's elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis)

other, NEC: Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia
Osteopathiesdisorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone (Pseudarthrosis, Stress fracture) - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis
Osteomyelitis - Avascular necrosis - Paget's disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis
ChondropathiesJuvenile osteochondrosis (Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever's disease) - Osteochondritis - Tietze's syndrome
See also congenital conditions (Q65-Q79, 754-756)
  This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Hypersensitivity_vasculitis". A list of authors is available in Wikipedia.
Your browser is not current. Microsoft Internet Explorer 6.0 does not support some functions on Chemie.DE