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Vasculitis

Vasculitis is a term to describe multisystem diseases, broadly classified by the size of involved blood vessels. 

Features suggesting a vasculitis in adolescents and children

Clinical

  • Fever, weight loss, persistent fatigue
  • Skin rash: e.g palpable purpura, vasculitic urticaria, nodules, ulcers, mouth ulcers
  • Neurologic signs: headache, mononeuritis multiplex, focal neurological lesions (stroke)
  • Arthritis or arthralgia, myalgia or myositis
  • Hypertension, cardiac failure, unequal pulses
  • Testicular pain 
  • Oliguria, haematuria, oedema
  • Pulmonary infiltrates or haemorrhage

Laboratory

  • Increased acute - phase reactants (ESR, CRP)
  • Anaemia, leukocytosis
  • Eosinophilia
  • Antineutrophil cytoplasmic antibodies (ANCA) *
  • Elevated factor VIII - related antigen (von Willebrand factor)
  • Haematuria

The most common childhood vasculitides are Henoch – Schönlein purpura (HSP) and Kawasaki Disease (KD) 

The following photographs demonstrate examples of vasculitis involving different systems

The photograph below shows vasculitic ulcers due to polyarteritis nodosa 

The photograph below shows livedo reticularis over the knee - a mottled skin appearance that associates with vasculitis and antiphospholipid syndromes


The photograph below shows ischaemic fingers in vasculitis with antiphospholipid syndrome

The photograph below shows an aphthous ulcer as a feature of small vessel vasculitis

The photographs show gangrenous toes (polyarteritis nodosa) and severe ischaemia on the vascular imaging (left foot more so than the right)


 The photograph below shows amputations due to digital ischaemia in polyarteritis nodosa

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