Which clinical history findings are characteristic of vasculitis?

Updated: Dec 10, 2018
  • Author: Nadia Jennifer Chiara Luca, MD; Chief Editor: Lawrence K Jung, MD  more...
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Answer

As vasculitides are systemic processes, a comprehensive history and full review of systems is necessary.

Possible triggers include the following:

  • Recent infections (upper respiratory tract infections, especially streptococcal, tuberculosis [TB])

  • Vaccinations - Eg, an Italian study found evidence that the measles-mumps-rubella (MMR) vaccine increases the risk of Henoch-Schönlein purpura (odds ratio = 3.4) [23]

  • New medications

Presenting features include the following:

  • Constitutional symptoms - Fever, weight loss, fatigue, malaise (These occur in 90-100% of patients with granulomatosis with polyangiitis [GPA], formerly Wegener granulomatosis) and microscopic polyangiitis [MPA]. [19, 7]

  • Skin – Nodules, which may be painful, erythematous, or ulcerated; purpura; petechiae; papulopustular lesions; erythema nodosum; livedo reticularis; Raynaud phenomenon; lower extremity swelling

  • Recurrent oral and/or genital ulcerations that heal with scarring

  • Nasal/sinus – Allergic rhinitis, nasal congestion, recurrent epistaxis, sinus pain, tearing

  • Pulmonary – Chronic cough, hemoptysis, shortness of breath, stridor, wheezing, chest pain

  • Musculoskeletal – Joint pain or swelling, myalgias, calf pain

  • Renal – Hematuria, hypertension

  • GI tract – Abdominal pain, hematochezia, vomiting, nausea

  • Genitourinary – Testicular swelling and/or pain

  • Vascular – extremity claudication, blood pressure difference between limbs, pre-syncope/fainting spells

  • Neurological – Headache, seizure, focal neurological deficits (eg, stroke, cranial nerve palsy, vision loss, fine motor deficits, movement abnormalities), diffuse neurological deficits (eg, cognitive decline, poor school performance), mononeuropathy or polyneuropathy (eg, numbness, paresthesias, hand/foot drop, weakness), visual/auditory hallucinations, fluctuating/decreased level of consciousness/encephalopathy

Past medical history may include the following:

  • Recurrent sinusitis and pneumonias

  • Asthma and allergic rhinitis precede development of Churg-Strauss syndrome

Family history may include an increased risk of Kawasaki disease in siblings.


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