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| Hypersensitivity vasculitis Classification and external resources |
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| ICD-10 | M31.0 |
|---|---|
| ICD-9 | 446.2 |
| DiseasesDB | 7423 |
| eMedicine | med/2930 |
| MeSH | D018366 |
Hypersensitivity vasculitis (or hypersensitivity angiitis or leukocytoclastic vasculitis) is a small vessel vasculitis,1 usually due to a hypersensitivity reaction.
Contents |
Causes
It is usually due to a known drug (such as cefoperazone2 or nicoumalone3), 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.
Clinical Presentation
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. This disorder may affect the skin only, but sometimes affect nerves, the kidneys, joints and the heart. Renal involvement is common.
Investigations
The primary goal is to identify 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
An important differential is Henoch-Schönlein purpura. 4
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
- ^ hypersensitivity vasculitis at Dorland's Medical Dictionary
- ^ Islek I, Baris S, Katranci AO, Ariturk E, Gurses N (January 2003). "Hypersensitivity vasculitis induced by cefoperazone/sulbactam". Ann. Clin. Microbiol. Antimicrob. 2: 1. PMID 12556245. PMC: 149382, http://www.ann-clinmicrob.com/content/2//1.
- ^ Susano R, Garcia A, Altadill A, Ferro J (April 1993). "Hypersensitivity vasculitis related to nicoumalone". BMJ 306 (6883): 973. PMID 8490477.
- ^ Michel BA, Hunder GG, Bloch DA, Calabrese LH (1992). "Hypersensitivity vasculitis and Henoch-Schönlein purpura: a comparison between the 2 disorders". J. Rheumatol. 19 (5): 721–8. PMID 1613701.
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Wikipedia content modification information:
- This page was last modified on 22 September 2008, at 13:13.
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