Angiitis

Thromboembolism or fat embolism, thrombophlebitis, necrotizing angiitis, syncopal episodes, cardiac arrhythmias, aggravation of hypertension... 

Immune vasculitis can also be induced by drugs. The sulfonamides, penicillin, thiouracil, anticonvulsants, and iodides have all been implicated in the initiation of hypersensitivity angiitis. Erythema multiforme is a relatively mild vasculitic skin disorder that may be secondary to drug hypersensitivity. Stevens-Johnson syndrome is probably a more severe form of this hypersensitivity reaction and consists of erythema multiforme, arthritis, nephritis, central nervous system abnormalities, and myocarditis. It has frequently been associated with sulfonamide therapy. Administration of nonhuman monoclonal or polyclonal antibodies such as rattlesnake antivenin may cause serum sickness. 

B14. Brauerman, I. M., and Yen, A., Demonstration of immune complexes in spontaneous and histamine-induced lesions and in normal skin of patients with leukocytoclastic angiitis. ]. Invest. Dermatol. 64, 105-112 (1975). 

Primary angiitis of the CNS causes inflammation particularly in small leptomeningeal vessels, whereas larger vessels can also be affected. Systemic variants of vasculitis and secondary arteritis of the CNS affect mostly small or medium-sized arteries to different degrees, and occasionally the venous system is also afflicted as in Behcet disease. Segmental stenoses are frequently found, often not including bifurcations and alternating with arterial dilatations. This pattern is not definitively specific and can also be seen in atherosclerosis. Even with an optimal MRA technique, DSA still remains necessary for the depiction of tiny vessel lesions (Fig. 5.26). 

Relapsing polychondritis Progressive systemic sclerosis Sarcoid angiitis... 

Gullapalli D, Phillips LH, II (2004). Neurosarcoidosis. Current Neurology and Neuroscience Reports 4 441-447 Hankey GJ (1991). Isolated angiitis/angiopathy of the central nervous system. Cerebrovascular Diseases 1 2-15 Harrison CN, Linch DC, Machin SJ (1998). Desirability and problems of early diagnosis of essential thrombocythemia. Lancet 351 846-847... 

Reijula K, Sutinen S, Tuuponen T, Lahti R, Karkola P Pulmonary fibrosis, with sarcoid granulomas and angiitis, associated with handling of mouldy lichen. Eur J Respir Dis 1983 64 625-629. Yoshida K, Ueda A, Yamasaki H, Sato K, Uchida K, Ando M Hypersensitivity pneumonitis resrrlt-ing from A. fumigatus in a greenhouse. Arch Environ Health 1993 48 260-262. 

Cury D, Breakey AS, Payne BF. Allergic granulomatous angiitis associated with uveoscleritis and papilledema. Arch Ophthalmol 1956 55 261-266. 

Chumbley, L.C., Harrison, E.G., DeRemee, R.A. Allergic granulomatosis and angiitis (Churg-Strauss syndrome). Report and analysis of 30 cases. Mayo Clin. Proc. 1977 52 477 - 484... 

Surprisingly few adverse effects have been reported. They include sinus bradycardia, nausea, and a single report of vasospastic angiitis (4). 

Lin RY. Unusual autoimmune manifestations in furosemide-associated hypersensitivity angiitis. NY State J Med 1988 88(8) 439-40. 

Churg-Strauss vasculitis (allergic angiitis and granulomatosis) has been attributed to hepatitis B immunization... 

A 50-year-old woman was given interferon alfa for chronic hepatitis C and primary biliary cirrhosis, and within 2 months became febrile and developed a diffuse nodular erythematous rash. The skin biopsy showed typical features of necrotizing angiitis, and cutaneous periarteritis nodosa was diagnosed. Full recovery was obtained after interferon alfa withdrawal and prednisolone treatment. 

Two cases of biopsy-proven cutaneous polyarteritis nodosa with positive perinuclear antineutrophilic cytoplasmic antibodies have been reported with long-term use of minocycline for acne vulgaris (50-100 mg/day for 44 months and 100 mg/day for 65 months) (52). In one of the cases, involvement was not restricted to medium-size vessels alone. In both cases the vasculitis disappeared after a short course of prednisone (40 mg/day) and withdrawal of minocycline. Rechallenge was not performed. P-ANCA is usually found in microscopic poly angiitis, a vasculitis of smaller arteries, and its significance in polyarteritis nodosa is not clear. 

Generalized reactions (26) include cutaneous necrotizing vasculitis (SEDA-5, 106) (SEDA-17, 113), nephritis, paralytic ileus, and angiitis with cutaneous, muscular, articular, and renal involvement (21). 

Acute lung reactions to nitrofurantoin are extremely rare in children (12). Lung tissue findings in acute reactions have shown minor vasculitis, granulomatous vasculitis (hypersensitivity angiitis), proliferation of endothelial cells, and empty alveoli (13). Rapidly progressing bronchiolitis obliterans with organizing pneumonia (BOOP) has been reported (14). 

Respiratory reactions to sulfonamides include migratory pulmonary infiltrates, chronic pneumonia, asthma, and pulmonary angiitis. These reactions are thought to be mainly due to hypersensitivity, although the precise mechanisms are not well understood (14-16). The link to the drug has been proven in most cases by recurrence after re-exposure to the same sulfonamide or to co-trimoxazole. 

Sorber WA, Herbst V. Lymphocytic angiitis following streptokinase therapy. Cutis 1988 42(l) 57-8. 

Amphetamines are sympathomimeticamines with central nervous system stimulatory activity. They may induce a number of patterns of renal damage including rhabdomyolysis related acute kidney injury, acute interstitial nephritis and an angiitis resembling polyarteritis nodosa. 

Citron BP, Halpern M, McCarron M, Lund berg GD, McCormick R, Pincus IJ, Tatter D, Haverback BJ. Necrotizing angiitis associated with drug abuse. N Engl J Med 1970 283 1003-1011. 

Koff RS, Widrich WC, Robbins AH. Necrotizing angiitis in a methamphetamine user with hepatitis B. N Engl J Med 1973 288 946-947. 

Lignelli GJ, BuchheitWA. Angiitis in drug abuse. N Engl J Med 1971 284 112-123. 

Allergic granulomatous angiitis (Churg-Strauss syndrome)... 

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