{"id":9328,"date":"2021-12-19T00:23:58","date_gmt":"2021-12-18T22:23:58","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-patomechanism-symptoms-treatment\/"},"modified":"2022-02-12T13:29:22","modified_gmt":"2022-02-12T11:29:22","slug":"medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/","title":{"rendered":"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment)"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h2 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\" class=\"title_collection title1\">Introduction<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Vasculitis is essentially an inflammation of the vessel wall. It can be either <strong>infectious<\/strong> or <strong>non-infectious<\/strong> (autoimmune).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Generally, &#8220;vasculitis&#8221; is often mentioned on its own, referring to the latter (non-infectious) form. It is classified based on the vessel size (large vessels such as the aorta and its branches, medium vessels, and small vessels).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" id=\"mechanisms\" class=\"wp-block-heading\" id=\"mechanisms\" class=\"title_collection title2\">Mechanisms<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Immune complex deposition<\/li><li>Neutrophil-mediated (ANCAs; pauci-immune)<\/li><li>Anti-endothelial activity<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h2 class=\"wp-block-heading\" id=\"medium-vessel-vasculitides\" class=\"wp-block-heading\" id=\"medium-vessel-vasculitides\" class=\"title_collection title1\">Medium vessel vasculitides<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The two entities in this group are the <strong>polyarteritis nodosa <\/strong>and <strong>Kawasaki disease<\/strong>.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" id=\"polyarteritis-nodosa-pan\" class=\"wp-block-heading\" id=\"polyarteritis-nodosa-pan\" class=\"title_collection title2\">Polyarteritis nodosa (PAN)<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">PAN affects small and medium-sized muscular arteries of the viscera, without affecting the lungs. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The vessels have segments (nodules) of fibrinoid necrosis and inflammation appearing with a &#8220;<em>beads on a string<\/em>&#8221; arrangement, most commonly at points of bifurcation. The nodules are of different age, i.e. each lesion appears at a different time.<\/li><li>It is immune-complex mediated, with most cases being idiopathic. 20-30% of patients have hepatitis virus.<\/li><li>Affected organs include the kidneys, GI tract, skin and subcutanous tissue, muscles, joints and nerves.<\/li><li>There is no granuloma formation.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"symptoms\" class=\"wp-block-heading\" id=\"symptoms\" class=\"title_collection title3\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Depending on the affected organ\/tissue:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Cutanous manifestations.<\/strong> Nodules, ulcers, infarctions, livido reticularis.<\/li><li><strong>Renal<\/strong>. PAN can cause renal ischemia, HTN, and renal failure but not glomerulonephritis (which is characteristic for small-vessel vasculitis).<\/li><li><strong>GI.<\/strong> Abdominal pain, nausea, perforation, acute abdomen.<\/li><li><strong>Nervous system<\/strong>. Mononeuritis multiplex (affecting single nerves in different locations).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title3\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">The clinical presentation may resemble a variety of diseases, therefore, the diagnosis is difficult.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Inflammation markers (ESR, CRP)<\/li><li>OFBT<\/li><li>Angiography<\/li><li>Biopsy of an affected vessel demonstrating nodules of different age with fibrinoid necrosis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title3\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Corticosteroids<\/li><li>DMARDs (methotrexate, cyclophosphamide, azathioprine)<\/li><li>Treatment of hepatitis if present<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" id=\"kawasaki-disease\" class=\"wp-block-heading\" id=\"kawasaki-disease\" class=\"title_collection title2\">Kawasaki disease<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">Kawasaki disease predominantly affects infants and young children of Asian descent, involving the coronary arteries, and typically arising together with a rash, oral and conjunctival blisters, and lymphadenopathy.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Life-threatning cardiac manifestations can occur within a few weeks if left untreated (peri\/endo\/myocarditis, arrhythmias, heart failure, coronary artery anyeurysm and rupture).<\/li><li>Unknown etiology, probably associated with an abnormal response to an infection leading to anti-endothelial activity.<\/li><li>More common in boys ages 3-5.<\/li><li>Kawasaki may resemble other diseases, e.g. scarlet fever caused by streptococcal infection.<\/li><li><strong>Clinical presentation<\/strong><ul><li>Begins with non-specific symptoms (fever, malaise) and lymphoadenopathy<\/li><li>After 2 days, conjunctival bilsters appear<\/li><li>After 5 days, a rash appears on the trunk, hands, and feet, along with oral blisters and a &#8220;strawbetter tongue&#8221;<\/li><\/ul><\/li><li><strong>Diagnosis<\/strong><ul><li>Clinical findings (fever lasting >5 days, rashes, blisters, lymphadenopathy)<\/li><li>ECG and echocardiography<\/li><\/ul><\/li><li><strong>Treatment<\/strong><ul><li>High-dose aspirin<\/li><li>High-dose IVIG<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Aspirin is contraindicated for use in children except for Kawasaki disease, as it may cause <em>Reye&#8217;s syndrome <\/em>(liver and CNS damage) in case of viral infections such as influenza or varicella.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h2 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\">Introduction<\/h2><h3 class=\"wp-block-heading\" id=\"mechanisms\" class=\"wp-block-heading\" id=\"mechanisms\">Mechanisms<\/h3><h2 class=\"wp-block-heading\" id=\"medium-vessel-vasculitides\" class=\"wp-block-heading\" id=\"medium-vessel-vasculitides\">Medium vessel vasculitides<\/h2><h3 class=\"wp-block-heading\" id=\"polyarteritis-nodosa-pan\" class=\"wp-block-heading\" id=\"polyarteritis-nodosa-pan\">Polyarteritis nodosa (PAN)<\/h3><h4 class=\"wp-block-heading\" id=\"symptoms\" class=\"wp-block-heading\" id=\"symptoms\">Symptoms<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><h3 class=\"wp-block-heading\" id=\"kawasaki-disease\" class=\"wp-block-heading\" id=\"kawasaki-disease\">Kawasaki disease<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Introduction Vasculitis is essentially an inflammation of the vessel wall. It can be either infectious or non-infectious (autoimmune). Generally, &#8220;vasculitis&#8221; is often mentioned on its own, referring to the latter (non-infectious) form. It is classified based on the vessel size (large vessels such as the aorta and its branches, medium vessels, and small vessels). Mechanisms [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":9306,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9328","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\\\/\",\"name\":\"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment) &#8211; Meddists\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\"},\"datePublished\":\"2021-12-18T22:23:58+00:00\",\"dateModified\":\"2022-02-12T11:29:22+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\\\/\\\/meddists.com\\\/learn\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinical\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Internal medicine\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Immunology\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/immunology\\\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment)\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/\",\"name\":\"Meddists\",\"description\":\"Let&#039;s Get Studying\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/meddists.com\\\/learn\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment) &#8211; Meddists","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/","url":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/","name":"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment) &#8211; Meddists","isPartOf":{"@id":"https:\/\/meddists.com\/learn\/#website"},"datePublished":"2021-12-18T22:23:58+00:00","dateModified":"2022-02-12T11:29:22+00:00","breadcrumb":{"@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/medium-vessel-vasculitides-classification-pathomechanism-symptoms-treatment\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/meddists.com\/learn\/"},{"@type":"ListItem","position":2,"name":"Clinical","item":"https:\/\/meddists.com\/learn\/clinical\/"},{"@type":"ListItem","position":3,"name":"Internal medicine","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/"},{"@type":"ListItem","position":4,"name":"Immunology","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/immunology\/"},{"@type":"ListItem","position":5,"name":"Medium vessel vasculitides (classification, pathomechanism, symptoms, treatment)"}]},{"@type":"WebSite","@id":"https:\/\/meddists.com\/learn\/#website","url":"https:\/\/meddists.com\/learn\/","name":"Meddists","description":"Let&#039;s Get Studying","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/meddists.com\/learn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/comments?post=9328"}],"version-history":[{"count":9,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9328\/revisions"}],"predecessor-version":[{"id":10601,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9328\/revisions\/10601"}],"up":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9306"}],"wp:attachment":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/media?parent=9328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}