0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

The ESR is elevated above 50

mm/hr in most patients with

giant cell arteritis. Start

prednisone 1—2 mg/kg/day

immediately to prevent

irreversible blindness.

Drugs That induce

SLE—

HIPPS

Hydralazine

INH

Phenytoin

Procainamide

Sulfonamides

TABLE 9.16. Large Vessel Vasculitis

SYNDROME SIGNS/SYMPTOMS DIAGNOSIS TREATMENT

Giant cell arteritis Involvement of Temporal artery biopsy Prednisone

branches of carotid artery ESR >50 mm/hr

→headache, jaw

claudication, scalp

tenderness, vision changes.

Takayasu’s arteritis Involvement of aorta and Aortic arch arteriogram Prednisone

major branches →finger

ischemia, arm claudication.

TREATMENT

■ NSAIDs for arthritis, arthralgias, serositis

■ Hydroxychloroquine for rash, malaise, arthralgias

■ Steroids for life-threatening manifestations, acute flares, symptoms refrac-

tory to conservative therapy

■ Immunosuppressive therapy

COMPLICATIONS

■ Nephrotic syndrome or renal failure

■ Purulent pericarditis (S. aureus)

■ Pleural effusion/tamponade

■ Interstitial lung disease, pulmonary hypertension

■ Coronary artery vasculitis with acute myocardial infarction

■ Libman-Sacks endocarditis: A noninfectious endocarditis

■ Mesenteric vasculitis

A 70-year-old woman presents with new-onset severe, throbbing, unilat-

eral headache. She has also noted proximal muscle weakness and blurry

vision. Physical exam shows tender, pulseless temporal artery and vision

loss. What’s the suspected diagnosis and next step?

Temporal arteritis (giant cell arteritis). The patient will require immediate high-

dose oral steroids and temporal artery biopsy within 1—2 days.

Vasculitis

Vasculitis is inflammation and necrosis of blood vessels leading to tissue damage.

This may affect different types and sizes of blood vessels. See Tables 9.16, 9.17,

and 9.18.

An infant is status post–cardiac transplant for myocarditis. How might acute

cardiac rejection present?

Feeding intolerance, fever, or fussiness.

The classic case of Henoch-

Schönlein purpura is a boy

between 2 and 11 years old

who presents with palpable

purpura on his legs, edema,

and abdominal pain with a

history of recent URI.