67. Vasculitis

Question 1

List of vasculitis types

Answer 1

• Takayasu disease
• Kawasaki disease
• Henoch purpura
• Behcet disease

Question 2

Takayasu disease: definition

Answer 2

Autoimmune disease characterized by acute vasculitis of Aorta and its branches

Question 3

Takayasu age:

Answer 3

15-40 yr old women

Question 4

Takayasu etiology

Answer 4

HLA B39

Question 5

Takayasu pathophysiology

Answer 5

T lymphocytes antigens on aorta wall —> Release cytokines —> Inflammation and dmg of aorta wall —> Aneurysm / stenosis / occlusion

Question 6

Takayasu CF:

Answer 6

• Fever ( Cytokine release )
• Weak pulse, claudication pain of extremities, stroke symptoms ( stenosis / occlusion —> low perfusion )
• Reynaud’s ( Low perfusion )
• Syncope, dyspnea ( Potential HF )
• Difference in BP between arms, Angina ( aneurysm )

Question 7

Takayasu: diagnosis

Answer 7

DIAGNOSTIC CRITERIA

1) Fever

2) Claudication of extremities

3) Weak pulse

4) Difference in BP between 2 arms

5) Whooshing sound over aorta

6) CT / MRI shows aorta stenosis / occlusion / aneurysm

Question 8

Takayasu treatment

Answer 8

• GC / cyclophosphamide
• Surgical correction of Aorta if severe

Question 9

Kawasaki disease: definition

Answer 9

• inflammation of intermediate BV in response to idiopathic infectious trigger

Question 10

Kawasaki disease: age

Answer 10

< 5 yrs

Question 11

Kawasaki disease: etiology

Answer 11

Infectious trigger such as Staph / strep antigen

Question 12

Kawasaki pathophysiology

Answer 12

Infectious trigger —> Massive T-lymphocyte activation of cytokines —> Damage BV endothelial cells

Question 13

Kawasaki CF + Diagnosis:

Answer 13

CF DIAGNOSIS:

• Fever ( Cytokine releases )
• Cervical lymphadenopathy
• Strawberry tongue, red swollen lips ( Inflammation of BV in oral mucosa
• Red palms ( Inflammation of BV in palms
• Conjunctivitis ( inflammation of BV in conjunctiva )
• Coronary aneurysms

Question 14

Kawasaki: treatment

Answer 14

• IV Immunoglobin therapy
• Aspirin if coronary artery is inflammed
• CS if IV doesnt work

Question 15

Henoch Purpura: definition

Answer 15

(aka IgA vasculitis)
Vasculitis of small BV associated with URTI

Question 16

Henoch Purpura: age

Answer 16

young children

Question 17

Henoch purpura: etiology

Answer 17

URTI —> IgA immune complexes deposited in BV —> inflammation of BV

Question 18

Henoch Purpura: CF

Answer 18

• Nephritis, hematuria, proteinuria ( BV inflammation in kidneys )
• Petechia, purpura ( BV inflammation in skin )
• Abdominal pain, vomiting, diarrhea ( BV inflammation in GIT )
• Arthritis ( BV inflammation in joints )

Question 19

Henoch purpura: Diagnosis

Answer 19

Purpura / Petechia + 1 of:

• arthritis
• vomiting, diarrhea, abdominal pain
• Hematuria, proteinuria, nephritis
• IgA in renal / skin biopsy

Question 20

Henoch purpura: treatment

Answer 20

Mild —> NSAIDS

Severe —> CS

Renal failure —> Dialysis

Question 21

Behcets’s disease: definition

Answer 21

Autoimmune disease characterized by vasculitis of small BV

Question 22

Behcet’s disease: Etiology

Answer 22

HLA B51

Question 23

Behcet’s disease: CF

Answer 23

• Sores in mouth and genitals ( inflammation of BV in mouth and genitals )
• Uveitis ( inflammation of BV in eyes )
• Arthritis ( inflammation of BV in joints )

Question 24

Behcet’s diagnosis

Answer 24

Clinical

Question 25

Behcet's treatment

Answer 25

Analgesics and NSAIDS