Hypersensitivity vasculitis

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Hypersensitivity vasculitis
ICD-10 M31.0
ICD-9 446.2
DiseasesDB 7423
eMedicine med/2930 
MeSH C14.907.940.910

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Hypersensitivity vasculitis

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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, LCV, leucocytoclastic venulitis, small-vessel vasculitis, cutaneous leukocytoclastic angiitis

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.

Pathophysiology

Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes who in turn release tissue-degrading substances leading to an inflammatory process. This disorder may affect the skin only, but sometimes affect nerves, the kidneys, joints and the heart. Renal involvement is common.

Causes

Diagnosis

History

A detailed history should be obtained regarding medications and potential exposure to infectious agents.

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.

Laboratory Studies

The following studies are routinely obtained:

Skin Biopsy

Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules.

Diagnostic Criteria

At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:

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


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