Vasculitis

• very rare in real life
• organ specific symptoms because vessel lumen occludes

• increase blood flow or hyperemia: blanch when pressed

• see palpable purpura = vasculitis

Large Vessel

Temporal Arteritis

• face and head symptoms
• ophthalmic artery from internal carotid

• High ESR: classic
• granuloma
• high IL6

Takayasu

• 30 yrs old age of onset

• picture: narrowing of left subclavian artery
• weak upper extremity pulse
• cold/numb fingers
• granuloma on histology

Medium Vessel

Kawasaki

• right: aneurysm

• acute: 1st 2 weeks, fever, arthritis, myocarditis, rash
• subacute: skin falls off, aneurysm

Scarlet

• scarlet fever: sore throat

Reye

Buerger

• aka thromboangiitis obliterans
• male smokers. Almost never in nonsmokers
• segmental thrombosing vasculitis: blood clots cut off blood to hands/feet
• distal claudication and ulcers
• characterized histologically by intraluminal thrombus and prominent inflammatory cell infiltrate with relative sparing of the vessel wall.

PAN

• deposit in many places, wide variety of symptoms

• transmural

• ischemia and renal failure

Small vessels

HS purpura

• complement activated via alternative/lectin pathway. IgA does not fix complement

• biopsy shows IgA deposition

ANCA

• pulmonary different for each; renal similar for all 3
• lower right: negative IF, no Ig

Churg Strauss

• looks like asthma as adule first time refractory to medical therapy
• classic case: adult onset asthma with palpable purpura, eosinophila, p-ANCA

Wegener

• saddle nose due to ulcers

Microscopic polyangitis

Goodpasture

• positive Ig stain