Vasculitis

Vasculitis

1. Large vessels

   • Giant cell arteritis
     • Older people (50 yrs)
     • Arteries of the head
       • Temporal
       • Vertebral
       • Ophthalmic
         • Blindless
     • granulomas in tunica media
     • IEL fragmentation
     • increased ESR
   • Takayasu arteritis
     • Same histology as GCA
     • younger patients
       • 40 year old women
     • pulseless disease
     • Arch of aorta

2. Medium vessels

   • Polyarteritis nodosa
     • Systemic vasculiti
     • Kidney, liver, heart, GI
       • Spares pulmonary
     • transmural inflammation
     • HBV
     • Aneurysmal dilation
     • young adults
     • Finbrinoid necrosis of inner 1/2 of vessel
   • Kawasaki
     • Children <4y/o
     • Transmural inflammation
     • Type 2 hypersensitivity
     • Aneurysm
     • symptoms
       • Fever, self limiting disease
       • conjuctival and oral erythema
       • Edema of hands and feet
       • Skin rash with desquamation
       • Enlargement of cervical lymph nodes
     • IVIG and aspirin
   • Buerger's disease
     • Smoking
       • Hypersensitivity reaction to tobacco smoke
       • Males
     • Small arteries could be involved
     • Acute and chronic lesions (old and new)
       • Superimposed luminal thrombosis with micro abscesses
     • PMNs
     • Neurovascular bundle

3. Small vessels

   • Microscopic polyangitis
     • P-ANCA
     • Same as PAN, but in small vessels
     • No granulomas
   • Wegener's granulomatosis
     • Classic triad
       • Necrotizing granulomas of URT and LRT
         • Coalesce and forms nodules
           • Cavitation
             • Bilateral nodular and cavity infiltrates
       • Foocal necrotising or granulomatous vasculitis
       • Focal necrotising, crescentric glomerulonephritis
     • C-ANCA
     • middle aged
     • Renal disease with hypertension
   • Churg Strauss syndrome
     • granuloma
     • P-ANCA
     • Eosinophilia
     • A/w asthma