vasculitis - DM SEMINAR FEBRUARY 3, 2006 The Pulmonary...

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The Pulmonary Vasculitides R.SRINIVAS Department of Pulmonary Medicine DM SEMINAR FEBRUARY 3, 2006
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Pulmonary vasculitis-an classification perspective: The vasculitides are a group of clinically diverse conditions charac. by involvement of blood vessels in an inflammatory, occlusive and often destructive process. The lungs are affected in isolation or with systemic vasculitis often because of: 1. Large vascular bed 2. Proximity to inhaled antigens 3. Presence of vaso-active cells 4. Versatility of the immune system. Classification of the vasculitis has been notoriously controversial and a surfeit of systems exist. These are a group of uncommon diseases and only 500 cases of confirmed Wegener’s and 80 patients of Churg-strauss over 30 yr period in Mayo Clinic till 1995 . There are about 50 histological confirmed cases of Wegener's in India.
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Classification Of The Pulmonary Vasculitis: Descriptive( Leibow) Pathological( Saldana) Classic WG lymphocytes depleted, vasculitis Limited WG Necrotizing sarcoid granulomatosis benign lymphocytic, vasculitis lymphomatoid granulomatosis bronchocentric granulomatosis malignant lymphocytic, vasculitis Churg-strauss eosinophilic vasculitis. A) lung is the major involved organ: Includes WG, Churg-Strauss, microscopic polyangiitis, Necrotizing sarcoid granulomatosis B) Lung may be involved : Takayasu’s arteritis, Behcet’s syndrome, Classic PAN, cryoglobulinemic Vasculitis, Henoch-schonlein purpura. C) Part of the spectrum : CT-assoc vasculitis and vasculitis secondary to infection, drugs, or irradiation
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Clinicopathological Classification Of The Pulmonary Vasculitis: GROUP 1: Distinct Syndromes. Lung Involvement Invariable Wegener's granulomatosis lymphomatoid granulomatosis Necrotizing sarcoid granulomatosis bronchocentric granulomatosis Microscopic polyangitiis Takayasu’s Churg-strauss Goodpasture’s syndrome GROUP 2: Distinct Syndromes. Nonspecific pathology. Lung Involvement variable Henoch-schonlein Purpura R.A SLE PSS Sjogren’s Polymyositis/dermatomyositis Hypersenstivity Angitis Cryoglobulinemia Behcet’s GROUP 3: Vasculitis due to infection. A.. Specific: bacterial/fungal/ parasitic B. non-specific: IE/ Sepsis GROUP 4: Physical agent induced vasculitis: radiation/ cold GROUP 5: Overlap syndromes .
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Pathogenic Categories of Vasculitis z DIRECT INFECTION OF VESSELS { Bacterial vasculitis (e.g., neisserial)/ Spirochetal vasculitis (e.g., syphilitic)/Mycobacterial vasculitis (e.g., tuberculous)/ Rickettsial vasculitis (e.g., Rocky Mountain spotted fever)/ Fungal vasculitis (e.g., aspergillosis)/Viral vasculitis (e.g., herpes zoster) z NONINFECTIOUS IMMUNOLOGIC INJURY Immune complex-mediated vasculitis { Cryoglobulinemic vasculitis { Henoch-Schonlein purpura { Serum sickness vasculitis { Lupus vasculitis { Rheumatoid vasculitis { Infection-induced immune complex vasculitis (e.g. by hepatitis virus) { Some drug-induced vasculitis (e.g., sulfonamide-induced vasculitis) { Some paraneoplastic vasculitis { Goodpasture’s syndrome (mediated by anti-GBM antibodies ) Anti neutrophil cytoplasmic autoantibody (ANCA)-mediated ) {
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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vasculitis - DM SEMINAR FEBRUARY 3, 2006 The Pulmonary...

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