SFGH morning report pearls 6.26 Rash in a pt with AIDS/small vessel vasculitis

A few pearls from our discussion:

  • While >90% of henoch-Schonlein purpura cases occur in kids <10, adults are more likely to develop complications including 30% with residual chronic kidney disease
  • Herpes zoster incidence is higher in HIV-infected patients.  The risk of zoster is higher as CD4 counts fall, as well as increased during immune recovery following ART initiation
  • Eosinophilic folliculitis is oftentimes seen at low CD4 counts, primary therapy is starting antiretroviral therapy.  Oral itraconazole is oftentimes used as treatment, with unknown mechanism

Read on for more about small vessel vasculitis:

Evernote link:

http://www.evernote.com/l/AoN8zytSz8JK2KLbT7JVNSgNNHYOfpR8vXc/

Small vessel vasculitis:

  • Inflammatory leukocytes in vessel walls
  • Physical exam:
    • lesions typically non blanchable, palpable purpura, superficial ulcers can occur
  • Workup: ANA, complement (low in mixed cryoglobulinemia and lupus), ANCA, biopsy

Primary vasculitis

  • Eosinophilic granulomatosis with polyangitis (churg-strauss)
    • small/medium
    • lung and skin involvement classic
  • Granulomatosis with polyangiitis (Wegener’s)
    • small/medium
    • upper and lower respiratory tract, kidney involvement common
    • ANCA associated
  • Microscopic polyangiitis
    • small/medium
    • ANCA associated, kidney involvement very common,
  • Henoch-schonlein purpura (IgA vasculitis)
    • tissue deposition of IgA-containing complexes
    • a form of hypersensitivity vasculitis
    • bowel angina, GI bleed, hematuria, palpable purpura; associated with arthralgias/arthritis
    • in adults, 30-80% have kidney involvement, 30% have residual CKD
  • Cryoglobulinemic vasculitis:
    • cryoglobulins – serum proteins composed of immunoglobulins and complement
  • hypersensitivity vasculitis
    • drug related, maculopapular rash

Secondary vasculitides:

  • Vasculitis secondary to connective tissue disorder:
    • lupus, rheumatoid arthritis, behcet’s
  • infections
    • virus: HIV, CMV
    • bacteria
    • fungi
    • parasites
  • neoplasia
  • drug induced

Gross et al: Diagnosis and evaluation of vasculitis. Rheumatology 2000;39:245-252

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