Hypersensitivity vasculitis: Difference between revisions
| Line 22: | Line 22: | ||
Hypersensitivity vasculitis is inflammation of the vessel wall which is usually due to a [[hypersensitivity reaction]] to a known drug, auto-antigens or infectious agents such as bacteria. [[Immune complexes]] lodge in the vessel wall, attracting [[polymorphonuclear leukocytes]] who in turn release tissue-degrading substances leading to an inflammatory process. | Hypersensitivity vasculitis is inflammation of the vessel wall which is usually due to a [[hypersensitivity reaction]] to a known drug, auto-antigens or infectious agents such as bacteria. [[Immune complexes]] lodge in the vessel wall, attracting [[polymorphonuclear leukocytes]] who in turn release tissue-degrading substances leading to an inflammatory process. | ||
== | == Diagnosis == | ||
Palpable, normally painful, petechiae or purpura (skin vasculitis). The lesions normally arise in crops, with common localizations being the forearms and legs. Necrosis of skin tissue can yield lesions with black or brown centres | |||
===Physical Examination=== | |||
====Skin==== | |||
*Palpable, normally painful, [[petechiae]] or [[purpura]] (skin vasculitis). | |||
*The lesions normally arise in crops, with common localizations being the forearms and legs. | |||
*[[Necrosis]] of skin tissue can yield lesions with black or brown centres. | |||
== Investigations == | == Investigations == | ||
Revision as of 13:46, 28 July 2013
| Hypersensitivity vasculitis | ||
| ICD-10 | M31.0 | |
|---|---|---|
| ICD-9 | 446.2 | |
| DiseasesDB | 7423 | |
| eMedicine | med/2930 | |
| MeSH | C14.907.940.910 | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Hypersensitivity angiitis, leukocytoclastic vasculitis
Overview
Hypersensitivity vasculitis is inflammation of the vessel wall which is usually due to a hypersensitivity reaction to a known drug, auto-antigens or infectious agents such as bacteria. Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes who in turn release tissue-degrading substances leading to an inflammatory process.
Diagnosis
Physical Examination
Skin
- Palpable, normally painful, petechiae or purpura (skin vasculitis).
- The lesions normally arise in crops, with common localizations being the forearms and legs.
- Necrosis of skin tissue can yield lesions with black or brown centres.
Investigations
The primary goal is to identifiy the causing agent, be it a drug or a microbe. Questioning is important, as is a thorough physical examination, chest X-ray, ESR and biochemical organ tests. Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules. Tests for hepatitis virus, antinuclear antibodies, rheumatoid factor and cryoglobulins might be indicated.
Diagnostic Criteria
At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:
- Age >16.
- Use of possible triggering drug in relation to symptoms.
- Palpable painful purpura (the three P's).
- Maculopapular rash.
- Skin biopsy showing neutrophil infiltration around vessel.
Treatment
The most important part of the treatment is to eliminate the cause of the vasculitis, if at all possible. Antihistamines prove helpful to some patients. If the vasculitis is damaging organ systems such as the kidneys, immunosuppressive agents are indicated.
See also
References
Template:Diseases of the musculoskeletal system and connective tissue