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Vasculitis is an inflammatory disease of blood vessels.
It is characterised histologically by the accumulation of leukocytes within and around the vessel wall. It can be of neutrophilic (leukoclastic/non-leukoclastic), lymphocytic, eosinophilic, granulomatous or mixed cell type.
Endothelial damage by an infectious agent, parasite infestation, eridotoxin or immune complex deposition initiates local inflammation, neutrophil accumulation and complement activation. Neutrophils release lysosomal enzymes leading to necrosis of the vessel wall, thrombosis and haemorrhage.
Any animal can be affected, and the clinical significance depends on the number, size and type of vessels affected, and the presence of thrombosis, ischaemia and infarction.
Idiopathic (50% of cases)
Cold agglutinin disease
Erythema nodosum-like panniculitis
Food hypersensitivity causing urticarial vasculitis
Clinical features of vasculitis are variable and depend on the vessels involved. It can present as: purpura, haemorrhagic bullae, necrosis and punched-out ulcers. It often affects the extremities such as the ear tips, tail, lips, paws and oral mucosa, and can be painful.
The systemic signs usually reflect the organ involved (hepatopathy, arthropathy, myopathy...). There may also be vague systemic signs of illness: lethargy, lymphadenopathy, vague pain, pyrexia and weight loss.
Signs associated with immmune-mediated disease include: thrombocytopaenia and polyarthropathy.
Breed-related vasculitis include: familial cutaneous vasculopathy of German Shepherd Dogs, neutrophilic leukoclastic vasculitis of Jack Russell Terriers, ear margin vasculitis/seborrhea in Dachshunds.
Immunodiagnostics to consider include: ANA titre, Coombs test, and cold agglutinin test.
Haematology, biochemistry and urinalysis may reveal a systemic disease.
Lesions should be biopsied. Histopathological findings will include: neutrophilic, lymphocytic, eosinophilic, granulomatous or mixed cells in and around the vessels. There may be vascular necrosis and fibrin thrombi. Perivascular haemorrhage and oedema can occur.
Management depends on the underlying cause, and treatment of this is the first priority.
Antibiotics may be a first line of therapy if drug reaction is not suspected.
Immune-modulatory drugs which may help control an immune-mediated disease with concurrent vasculitis include: prednisolone, sulfasalazine, chlorambucil. These should always be used until remission and then doses decreased to the lowest possible dose for controlling clinical signs.
Prognosis is often guarded, and depends on the underlying cause.
Merck and Co (2008) Merck Veterinary Manual Merial
Weiss, D. (2011) Schalm's veterinary haematology John Wiley and Sons
Helton Rhodes, K. (2011) Blackwell's Five-Minute Veterinary Consult Clinical Companion: Dermatology Wiley-Blackwell
Day, M. (2010) Veterinary Immunology Manson Publishing
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