Difference between revisions of "Vasculitis"
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Vasculitis is an '''inflammatory disease of blood vessels'''. | Vasculitis is an '''inflammatory disease of blood vessels'''. | ||
| − | It is | + | 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. |
| − | It is a combination of '''type III and type I''' hypersensitivity reactions. | + | It is a combination of '''[[Type III Hypersensitivity|type III]] and [[Type I Hypersensitivity|type I]]''' [[:Category:Hypersensitivity|hypersensitivity]] reactions. |
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. | 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. | ||
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'''Staphylococcal hypersensitivity''' | '''Staphylococcal hypersensitivity''' | ||
| − | '''Food hypersensitivity causing urticarial vasculitis''' | + | '''Food hypersensitivity causing [[Urticaria|urticarial]] vasculitis''' |
'''[[FeLV]] and [[FIV]]-associated vasculitis''' in cats | '''[[FeLV]] and [[FIV]]-associated vasculitis''' in cats | ||
==Clinical Signs== | ==Clinical Signs== | ||
| − | Clinical features of vasculitis are variable and depend on the vessels involved. | + | 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/[[Ear Margin Dermatosis|seborrhea]] in Dachshunds. | |
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| − | '''Breed-related''' vasculitis include: familial cutaneous vasculopathy of German Shepherd Dogs, neutrophilic leukoclastic vasculitis of Jack Russell Terriers, Ear Margin | ||
==Differential Diagnoses== | ==Differential Diagnoses== | ||
| − | Ear margin seborrhea, chemical and thermal burns, hepatocutaneous syndrome, erythema multiforme, dermatomyositis and sepsis | + | [[Ear Margin Dermatosis|Ear margin seborrhea]], chemical and thermal burns, hepatocutaneous syndrome, erythema multiforme, [[Canine Dermatomyositis|dermatomyositis]] and sepsis |
==Diagnosis== | ==Diagnosis== | ||
| − | '''Immunodiagnostics''' to consider include: ANA titre, Coombs test, and cold agglutinin test. | + | '''Immunodiagnostics''' to consider include: ANA titre, [[Agglutination|Coombs test]], and cold agglutinin test. |
'''Haematology, biochemistry and urinalysis''' may reveal a systemic disease. | '''Haematology, biochemistry and urinalysis''' may reveal a systemic disease. | ||
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'''Antibiotics''' may be a first line of therapy if drug reaction is not suspected. | '''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. | + | '''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. |
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| − | 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. | Prognosis is often '''guarded''', and depends on the underlying cause. | ||
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Day, M. (2010) '''Veterinary Immunology''' ''Manson Publishing'' | Day, M. (2010) '''Veterinary Immunology''' ''Manson Publishing'' | ||
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| + | {{review}} | ||
| + | [[Category:Expert Review]] | ||
[[Category:Vascular Diseases - Dog]][[Category:Vascular Diseases - Cat]] | [[Category:Vascular Diseases - Dog]][[Category:Vascular Diseases - Cat]] | ||
| − | [[Category:Arterial_Pathology]][[Category:Venous_Pathology | + | [[Category:Arterial_Pathology]][[Category:Venous_Pathology]] |
Revision as of 22:03, 6 September 2011
Introduction
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.
It is a combination of type III and type I hypersensitivity reactions.
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.
Aetiology
Idiopathic (50% of cases)
Cold agglutinin disease
Disseminated Intravascular Coagulation
Lymphoreticular neoplasia
Drug reactions
Post-vaccine reactions
Spider bites
Immune-mediated disease
Erythema nodosum-like panniculitis
Rheumatoid arthritis
Staphylococcal hypersensitivity
Food hypersensitivity causing urticarial vasculitis
FeLV and FIV-associated vasculitis in cats
Clinical Signs
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.
Differential Diagnoses
Ear margin seborrhea, chemical and thermal burns, hepatocutaneous syndrome, erythema multiforme, dermatomyositis and sepsis
Diagnosis
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.
Treatment
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.
References
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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This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing. |