Vasculitis

  • very rare in real life
  • organ specific symptoms because vessel lumen occludes

  • increase blood flow or hyperemia: blanch when pressed

  • see palpable purpura = vasculitis

Large Vessel

Temporal Arteritis

  • face and head symptoms
  • ophthalmic artery from internal carotid

  • High ESR: classic
  • granuloma
  • high IL6

Takayasu

  • 30 yrs old age of onset

  • picture: narrowing of left subclavian artery
  • weak upper extremity pulse
  • cold/numb fingers
  • granuloma on histology

Medium Vessel

Kawasaki

  • right: aneurysm

  • acute: 1st 2 weeks, fever, arthritis, myocarditis, rash
  • subacute: skin falls off, aneurysm

Scarlet

  • scarlet fever: sore throat

Reye

Buerger

  • aka thromboangiitis obliterans
  • male smokers. Almost never in nonsmokers
  • segmental thrombosing vasculitis: blood clots cut off blood to hands/feet
  • distal claudication and ulcers
  • characterized histologically by intraluminal thrombus and prominent inflammatory cell infiltrate with relative sparing of the vessel wall.

PAN

  • deposit in many places, wide variety of symptoms

  • transmural

  • ischemia and renal failure

Small vessels

HS purpura

  • complement activated via alternative/lectin pathway. IgA does not fix complement

  • biopsy shows IgA deposition

ANCA

  • pulmonary different for each; renal similar for all 3
  • lower right: negative IF, no Ig

Churg Strauss

  • looks like asthma as adule first time refractory to medical therapy
  • classic case: adult onset asthma with palpable purpura, eosinophila, p-ANCA

Wegener

  • saddle nose due to ulcers

Microscopic polyangitis

Goodpasture

  • positive Ig stain