Tasty morsels of EM #139 – vasculitides

11 Jun

Found this in an old not in an old app and thought it was still a reasonable summary for EM purposes

Summarised from rosens 8th chapter 116

As always, happy to take comments and more importantly corrections!

Polyarteritis nodosa

  • Digital cyanosis

Takayasu’s

  • initially fever weight loss constitutional symptoms
  •  late followed by pulse differences and limb ischemia

Giant cell

  • affects internal (supplying the eye) and external (supplying masseter and superficial temporal) arteries.
  • if amaurosis fugax think GCA and stroke.

Buergers

  • smoking is key
  • typically lower limb pain and claudication.
  • associated ulceration

Bechet’s

  • chronic relapsing
  • oral ulceration early and essential
  • eye involvement about 70% (iritis)
  • can affect both small and large vessels

Wegener’s

  •  respiratory tract and kidneys
  • commonest manifestations are sinus related so good luck trying to diagnose that
  • can present as glomerulonephritis which will hopefully be easier
  • high (>80% 1 year mortality untreated)

Churg Strauss

  • linked with atopy (part of the diagnosis)
  • usually a couple of years of asthma symptoms prior to diagnosis

Microscopic polyangiitis

  • commonest cause of pulmonary renal syndrome (haemoptysis and glomerulonephritis)
  • mainly seen as rapidly progressive renal impairment

Goodpastures syndrome

  • I struggle to see anything that would clinically help me differentiate this from microscopic polyangiitis
  • both have alveolar bleeding and renal failure

HSP

  •  this is one we actually see fairly commonly
  • Often a preceding URTI
  •  rash arthralgia commonest
  • Abdominal pain and kidney problems too
  • usually self limiting over about 2 months
  • recurs in up to a third

Hypersensitivity vasculitis

  • usually drug related(though hard to prove)
  •  skin findings like HSP but no systemic findings

Mixed cryoglobulinemia

  • cryoglobulins are immune complexes that precipitate at 4 degrees
  • purpura weakness arthralgias
  • viral infections hep b and c EBV and CMV
  • if the cryoglobulins precipitate in the kidneys then there’s problems

Erythema nodosum

  •  inflammation of venules of skin
  •  strep sarcoid and TB are things that should come to mind.
  • Inflammatory bowel disease is a very uncommon cause of nodosum.

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