| Hypersensitivity vasculitis|
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Synonyms and Keywords: Hypersensitivity angiitis, leukocytoclastic vasculitis, LCV, leucocytoclastic venulitis, small-vessel vasculitis, cutaneous leukocytoclastic angiitis
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.
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 by Organ System
|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
- Acute infantile hemorrhagic edema
- Erythema elevatum diutinum
- Granuloma faciale
- Henoch-schönlein purpura
- Hepatitis b
- Hepatitis c
- Inflammatory bowel disease
- Rheumatoid arthritis
- Serum sickness
- Sjögren's syndrome
- Systemic lupus erythematosus
- Thiazide diuretics
A detailed history should be obtained regarding medications and potential exposure to infectious agents.
- 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.
The following studies are routinely obtained:
Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules.
At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:
- Age over 16 years
- Use of possible triggering drug in relation to symptoms
- Palpable painful purpura (the three P's)
- Maculopapular rash
- Skin biopsy showing neutrophil infiltration around vessels
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.