Rheumatology Book

Environmental Injury

Thromboangiitis

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Small Vessel Vasculitis

Aka: Small Vessel Vasculitis, Vasculitis of Small Vessels, ANCA-Associated Vasculitis, Antineutrophil Cytoplasmic Antibody Vasculitis
  1. See Also
    1. Vasculitis
  2. Epidemiology: Most common Small Vessel Vasculitis
    1. Older Adults: ANCA-associated Small Vessel Vasculitis
    2. Children: Henoch-Schonlein Purpura
  3. Type: ANCA-associated small-vessel Vasculitis
    1. Non-Granulomatous Disease
      1. Microscopic Polyangiitis
        1. Most common ANCA Vasculitis
        2. Lung and renal findings
      2. Drug-Induced Vasculitis (7-21 days after drug onset)
        1. Penicillin and Aminopenicillins
        2. Sulfonamides
        3. Allopurinol
        4. Thiazides
        5. Quinolones
        6. Hydantoins
        7. Propylthiouracil
        8. Hydralazine
    2. Granulomatous Disease
      1. Churg-Strauss Syndrome
        1. Associated with Asthma and Eosinophilia
      2. Wegener's Granulomatosis
        1. Lung, Renal, and upper respiratory signs
  4. Type: non-ANCA associated Small Vessel Vasculitis
    1. Paraneoplastic Small Vessel Vasculitis
    2. Inflammatory Bowel Disease
    3. Immune Complex Small Vessel Vasculitis
      1. Henoch-Schonlein Purpura (Lung and skin signs)
      2. Cryoglobulinemia (Lung and skin signs)
      3. Systemic Lupus ErythematosusVasculitis
      4. Rheumatoid Arthritis
      5. Goodpasture's Syndrome
      6. Sjogren's Syndrome
      7. Drug-induced immune-complex Vasculitis
      8. Infection-induced immune-complex Vasculitis
      9. Behcet's Disease
  5. Symptoms
    1. Fever
    2. Weight loss
    3. Malaise
    4. Myalgias and Arthralgias
    5. Dyspnea
    6. Cough (Hemoptysis may be present)
    7. Diarrhea
    8. Nausea or Vomiting
    9. Abdominal Pain
  6. Signs
    1. Dermatologic findings
      1. Palpable Purpura (duration longer than 24 hours)
      2. Urticaria
    2. Pulmonary findings
      1. Interstitial Lung Disease
      2. Pulmonary Hemorrhage
    3. Neurologic findings
      1. Peripheral Neuropathy
    4. Gastrointestinal findings
      1. Fecal blood positive
  7. Differential Diagnosis
    1. Embolic disease
    2. Sepsis
    3. Lymphoma
    4. Leukemia
    5. Myelodysplastic condition
  8. Labs
    1. Antineutrophil Cytoplasmic Antibodies (ANCA)
    2. Complete Blood Count (CBC)
      1. Normocytic Anemia
      2. Thrombocytosis
    3. Chemistry profile (e.g. Chem8)
      1. Renal Function tests may show Renal Insufficiency
    4. Liver Function Tests
      1. Increased liver enzymes
    5. Fecal Occult Blood
    6. Urinalysis (Glomerulonephritis)
      1. Hematuria
      2. Proteinuria
  9. Radiology: Chest XRay
    1. Interstitial Lung Disease findings may be seen
  10. Diagnostics
    1. Biopsy from symptomatic site (e.g. skin, lung, Kidney)
  11. References
    1. Calabrese in Ruddy (2001) Kelley's Rheum, p. 1165-7
    2. Mansi (2002) Am Fam Physician 65(8):1615-20 [PubMed]

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