Hypersensitivity vasculitis

ICD-10 | M31.0
ICD-9 | 446.2
DiseasesDB | 7423
eMedicine | med/2930
MeSH | C14.907.940.910

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2] Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: Hypersensitivity angiitis, leukocytoclastic vasculitis, LCV, leucocytoclastic venulitis, small-vessel vasculitis, cutaneous leukocytoclastic angiitis

## Contents

* 1 Overview
* 2 Pathophysiology
* 3 Causes
* 3.1 Causes by Organ System
* 3.2 Causes in Alphabetical Order
* 4 Diagnosis
* 5 History
* 6 Physical Examination
* 6.1 Skin
* 7 Laboratory Studies
* 8 Skin Biopsy
* 9 Diagnostic Criteria
* 10 Treatment
* 11 See also
* 12 References

## Overview

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Hypersensitivity vasculitis is inflammation of the vessel wall which is usually due to a hypersensitivity reaction to a known drug, auto-antigens or infectious agents such as bacteria.

## Pathophysiology

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Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes who in turn release tissue-degrading substances leading to an inflammatory process. This disorder may affect the skin only, but sometimes affect nerves, the kidneys, joints and the heart. Renal involvement is common.

## Causes

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### Causes by Organ System

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Cardiovascular | Vasculitis

|

Chemical/Poisoning | No underlying causes
Dental | No underlying causes
Dermatologic | Erythema elevatum diutinum, Granuloma faciale, Henoch-schönlein purpura
Drug Side Effect | Allopurinol, Amoxicillin, Azficel-t, Coumarin, Letrozole, Nsaids, Orlistat, Penicillin, Phenytoin, Sulfonamide, Thiazide diuretics, Thiouracil, Warfarin
Ear Nose Throat | Sjögren's syndrome
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | Inflammatory bowel disease
Genetic | No underlying causes
Hematologic | Acute infantile hemorrhagic edema, Cryoglobulinemia, Erythema elevatum diutinum, Henoch-schönlein purpura
Iatrogenic | No underlying causes
Infectious Disease | Hepatitis b, Hepatitis c
Musculoskeletal/Orthopedic | No underlying causes
Neurologic | No underlying causes
Nutritional/Metabolic | No underlying causes
Obstetric/Gynecologic | No underlying causes
Oncologic | Cancer, Granuloma faciale
Ophthalmologic | No underlying causes
Overdose/Toxicity | No underlying causes
Psychiatric | No underlying causes
Pulmonary | No underlying causes
Renal/Electrolyte | No underlying causes
Rheumatology/Immunology/Allergy | Rheumatoid arthritis, Serum sickness, Sjögren's syndrome, Systemic lupus erythematosus
Sexual | No underlying causes
Trauma | No underlying causes
Urologic | No underlying causes
Miscellaneous | No underlying causes

### Causes in Alphabetical Order

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## Diagnosis

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## History

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A detailed history should be obtained regarding medications and potential exposure to infectious agents.

## Physical Examination

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### Skin

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* Palpable, normally painful, petechiae or purpura (skin vasculitis).
* The lesions normally arise in crops, with common localizations being the forearms and legs.
* Necrosis of skin tissue can yield lesions with black or brown centres.

## Laboratory Studies

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The following studies are routinely obtained:

* Hepatitis serologies
* Antinuclear antibodies
* Rheumatoid factor
* Cryoglobulins

## Skin Biopsy

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Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules.

## Diagnostic Criteria

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At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:

* Age over 16 years
* Use of possible triggering drug in relation to symptoms
* Palpable painful purpura (the three P's)
* Maculopapular rash
* Skin biopsy showing neutrophil infiltration around vessels

## Treatment

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The most important part of the treatment is to eliminate the cause of the vasculitis, if at all possible. Antihistamines prove helpful to some patients. If the vasculitis is damaging organ systems such as the kidneys, immunosuppressive agents are indicated.

## See also

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* Vasculitis
* Goodpasture's syndrome
* Henoch-Schönlein purpura

## References

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