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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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

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

Causes by Organ System

Cardiovascular Vasculitis
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Erythema elevatum diutinum, Granuloma faciale, Henoch-schönlein purpura
Drug Side Effect Allopurinol, Amoxicillin, Azficel-t, Coumarin, Letrozole, Nsaids, Orlistat, Penicillin, Phenytoin, Sulfonamide, Thiazide diuretics, Thiouracil, Warfarin
Ear Nose Throat Sjögren's syndrome
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease
Genetic No underlying causes
Hematologic Acute infantile hemorrhagic edema, Cryoglobulinemia, Erythema elevatum diutinum, Henoch-schönlein purpura
Iatrogenic No underlying causes
Infectious Disease Hepatitis b, Hepatitis c
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Cancer, Granuloma faciale
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Rheumatoid arthritis, Serum sickness, Sjögren's syndrome, Systemic lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order


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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