Vasculitis

Question 1

List 4 types of vasculitis which affect the small sized vessels

Answer 1

1. Henoch-Schonlein purpura
2. Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)
3. Microscopic polyangiitis
4. Granulomatosis with polyangiitis (Wegener’s granulomatosis)

Question 2

List 3 types of vasculitis which affect the medium sized vessels

Answer 2

1. Polyarteritis nodosa
2. Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss syndrome)
3. Kawasaki Disease

Question 3

List 2 types of vasculitis which affect the large sized vessels

Answer 3

1. Giant cell arteritis
2. Takayasu’s arteritis

Question 4

List 4 features of a vasculitis

Answer 4

1. Purpura
2. Joint and muscle pain
3. Peripheral neuropathy
4. Renal impairment
5. GI disturbance (diarrhoea, abdominal pain and bleeding)
6. Anterior uveitis and scleritis
7. Hypertension

Question 5

List 4 systemic manifestations of vasculitis

Answer 5

• Fatigue
• Fever
• Weight loss
• Anorexia (loss of appetite)
• Anaemia

Question 6

Specific test findings for vasculitis

Answer 6

1. ANCA (p-ANCA and c-ANCA)
2. ↑CRP and ESR

Question 7

Compare pANCA vs cANCA

Answer 7

p-ANCA (MPO antibodies): Microscopic polyangiitis and Churg-Strauss syndrome

c-ANCA (PR3 antibodies): Wegener’s granulomatosis

Question 8

What is Henoch-Schonlein Purpura?

Answer 8

An IgA vasculitis that commonly presents with a purpuric rash affecting the lower limbs or buttocks in children (< 10 yrs)

Question 9

Most common cause of HSP?

Answer 9

Often triggered by an upper airway infection (e.g. tonsillitis) or a gastroenteritis

Question 10

Four classic features of HSP?

Answer 10

1. purpura (100%)
2. joint pain (75%)
3. abdominal pain (50%)
4. renal involvement (50%)

Question 11

Management of HSP

Answer 11

Supportive ie. simple analgesia, rest and proper hydration

Question 12

How does Eosinophilic granulomatosis with polyangiitis commonly present?

(Churg-Strauss syndrome)

Answer 12

Presents with severe asthma in late teenage years or adulthood

Most associated with lung and skin problems

Question 13

Characteristic finding on FBC of Churg-Strauss syndrome

Answer 13

↑ eosinophil levels

Question 14

Main feature of Microscopic polyangiitis

Answer 14

Renal failure

(can also affect the lungs causing SOB and haemoptysis)

Question 15

Classic presentation/features of Wegener’s granulomatosis?

(Granulomatosis with polyangiitis)

Answer 15

1. Epistaxis and crusty nasal secretions
2. Hearing loss and Sinusitis
3. Saddle shaped nose due to a perforated nasal septum
4. Cough, wheeze and haemoptysis
5. Glomerulonephritis

Question 16

What is Polyarteritis Nodosa?

Answer 16

Medium vessel vasculitis associated with hepatitis B

Associated with a rash called livedo reticularis. - mottled, purplish, lace like rash

Question 17

What is Kawasaki Disease

Answer 17

Medium vessel vasculitis which affects young children (< 5) with no clear cause

Question 18

Clinical features of Kawasaki Disease

Answer 18

1. Persistent high fever > 5 days
2. Erythematous rash
3. Bilateral conjunctivitis
4. Erythema and desquamation (skin peeling) of palms and soles
5. “Strawberry tongue”

Question 19

Key complication of Kawasaki Disease

Answer 19

coronary artery aneurysms

Question 20

Treatment of Kawasaki Disease

Answer 20

Aspirin and IV immunoglobulins

Question 21

What is Takayasu’s arteritis?

Answer 21

Large vessel vasculitis which mainly affects the aorta and it’s branches. It also affect the pulmonary arteries.

These can swell and form aneurysms or become narrowed and blocked which leads to it’s other name of “pulseless disease”

Question 22

How does Takayasu’s arteritis?

Question 23

How does Takayasu’s arteritis present?

Answer 23

Before 40 years with:

• Non-specific systemic symptoms: fever, malaise and muscle aches
• Specific symptoms: arm claudication or syncope

Question 24

How is Takayasu’s arteritis diagnosed

Answer 24

1. CT or MRI angiography
2. Doppler ultrasound of the carotids can be useful in detecting carotid disease