0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37
Cutaneous Vasculitis 445➣Lung involvement includes pleuritis, effusions, nodules, infil-
trates, or cavitation.
➣Neurologic involvement has symptoms of neuropathy, cephalal-
gia, intracranial hemorrhage.
➣Henoch-Schonlein purpura (HSP) – palpable purpura, abdomi-
nal pain, arthritis, nephritis
■Medium and large vessel vasculitis:
➣livedo reticularis, purpura, nodules, necrosis, ulceration
➣Systemic disease is similar to that seen with small vessel vasculi-
tis, but is more frequent and often more serious.tests
Laboratory
■Basic blood studies:
➣Complete blood count, sedimentation rate, cryoglobulin, serum
protein electrophoresis, hepatitis profile, anti-nuclear antibody,
serum complement levels, tests of renal and liver function
■Basic urine studies:
➣Look for hematuria or proteinuria, which can indicate possible
renal involvement.Screening
■Confirmatory Tests
➣Anti-neutrophil cytoplasmic antibody (ANCA) test to evaluate
type of vasculitis
➣p-ANCA non-specific, various vasculitides
➣c-ANCA is more specific for Wegener’s granulomatosis.Imaging
■Chest x-ray if there are pulmonary symptoms
■CT or MRI of head if there are central neurologic findings
■Mesenteric arteriography if skin findings of medium vessel vasculitis
and abdominal symptoms suggesting of polyarteritis nodosaBiopsy
■Skin biopsy to confirm vasculitis and type of vessel involved (small
or medium)
■Skin biopsy for direct immunofluorescence to evaluate type of
immunoglobulin in vessel wall. IgA is commonly seen in early HSP
lesions.
■Renal biopsy to evaluate possible renal vasculitis if type of renal
lesion unclear