Vasculitis

Many thanks to Dr. Marcia Friedman for this fantastic overview on vasculitis, a fascinating group of diseases!

Plugging-in a mnemonic I learned in medical school:

Small vessel vasculitis involves “SKELN” - skin, kidney, ENT, lung, nerve

—Mengyu (rheumatology enthusiast)

A few notes on pathology explanation:

  • Rash in small vessel vasculitis is non-blanching because blood vessels are damaged

  • Pathology of livedo reticularis: zone of arterial cone (hypoperfusing) +zone of venous drainage

  • Glomerulonephritis in small vessel vasculitis is featured by active urine sediments (RBC, protein, casts) - things that should stay in the blood spill into urine

  • DAH (ie, capillaritis) is a medical emergency, as there is nothing to tamponade. BAL is features by “bloodier and bloodier” tubes

  • Mononeuritis multiplex is a misnomer - it’s not nerve inflammation per se; it’s involvement of vasa nervorum which supplies the nerve, and the nerve becomes ischemic.

  • GCA causes loss of vision (anterior ischemic optic neuropathy), as well double vision (oculomotor palsy). Scleritis (painful red eye) is small vessel involvement.


Illness scripts:

  • GCA: >50 yo man

  • Takayasu: <40 yo Asian woman, presents withh…, found to have asymmetric pulse, …

  • PAN: hepatitis B

  • GPA:

  • EGPA: adult-onset asthma

  • MPA:

  • Cryoglobulinemic vasculitis: hepatitis C

  • IgA vasculitis (HSP):

  • anti-GBM



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Additional Reading

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Preoperative Risk Assessment

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Five Things All Internists Should Know About ILD