Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cutaneous Vasculitis Cyclosporiasis 447

Apheresis:severe vasculitis. This usually requires an immuno-

suppressive agent in addition to prevent rebound

follow-up

During Treatment

■Look for development of systemic symptoms. Follow skin exam and

other relevant organs. Monitor blood for toxicity related to drugs and

evidence of systemic vasculitis, urinalysis, Hemoccult stool.

Routine

■After skin lesions resolve, follow patient monthly or bimonthly until

off treatment. After that, follow yearly unless there is evidence of

active systemic disease or new symptoms develop

complications and prognosis

Complications

■Can develop systemic disease at any point. Delayed onset of renal

involvement after resolution of skin disease can occur in some forms

of vasculitis (Henoch-Schonlein purpura). Those with a generalized

distribution of lesions, with lesions not just on the lower extremities,

are at higher risk of systemic disease.

Prognosis

■An acute episode of vasculitis will often resolve and not recur. There

are certainly patients who have prolonged courses of skin-only

leukocytoclastic vasculitis and never progress to systemic disease.

Other patients can progress or initially have systemic disease, and

occasionally this can be chronic. Therapy must be targeted based

on the organs involved, and usually disease can be controlled, if not

eradicated.

Cyclosporiasis.......................................

J. GORDON FRIERSON, MD

history & physical

History

■Exposure: ingestion of cysts of Cyclospora cayetanensis via contam-

inated food and water (presumed mechanism, full life cycle not yet

demonstrated). Waterborne outbreaks described.