Vasculitis history and symptoms

Vasculitis
Overview
Classification Large-sized vessel vasculitis Takayasu's Arteritis Temporal Arteritis Medium-sized vessel vasculitis Kawasaki's Disease Polyarteritis Nodosa Small-sized vessel vasculitis Churg-Strauss Syndrome Cutaneous leukocytoclastic vasculitis Essential cryoglobulinemic vasculitis Henoch-Schonlein Purpura Microscopic polyangiitis Wegener's Granulomatosis Variable-sized vessel vasculitis Sjogren syndrome Cogan syndrome Single organ vasculitis Primary central nervous system angiitis
Causes
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

History

A detailed history is important to elicit any recent medications, any risk of hepatitis infection, or any recent diagnosis with a connective tissue disorder such as systemic lupus erythematosus (SLE).

Symptoms

Patients usually present with systemic symptoms with single or multiorgan dysfunction.

Common (and nonspecific) complaints include:

• Fatigue
• Weakness
• Fever
• Arthralgias
• Abdominal pain
• Hypertension
• Renal insufficiency
• Neurologic dysfunction

The following symptoms should raise a strong suspicion of a vasculitis:

• Mononeuritis multiplex. Also known as asymmetric polyneuropathy is highly suggestive of vasculitis, since diabetes is the only other cause of this.

• Palpable purpura. If patients have this in isolation, it is most likely due to cutaneous leukocytoclastic vasculitis. If the purpura is in combination with systemic organ involvement, it is most likely to be Henoch-Schonlein purpura or microscopic polyarteritis.

• Pulmonary-Renal. Patients with hemoptysis and renal involvement are likely to have Wegener's granulomatosis, microscopic polyangiitis, or anti-GBM disease (Goodpasture's syndrome).

Other relatively common symptoms include:

• Claudication of extremities
• New onset headache with localized tenderness - temporal arteritis
• Unexplained weight loss > 4 kg, testicular pain - Polyarteritis nodosa
• Nasal or oral inflammation (oral ulcers or purulent/bloody nasal discharge, may be painful) - Wegener's granulomatosis
• Asthma (history of wheezing or presently wheezing) - Churg-Strauss arteritis
• GI bleed, hematuria, mesenteric ischemia - Henoch-Schonlein purpura