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Hemorrhagic vasculitis: causes, treatment

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Hemorrhagic vasculitis Hemorrhagic vasculitis is an aseptic inflammation of the walls of the microvessels, accompanied by multiple microthrombus formation of the vessels of the skin, kidneys, intestines and other internal organs. The disease is most common in the group of systemic vasculitis, it was first described in 1837 by the German physician, Schönlein. Its name has many synonyms, the most common of them are rheumatic purpura, Schönlein-Genoch disease, Schönlein-Genoch disease. Under the last of these names, the disease is known abroad.



Causes of hemorrhagic vasculitis

In a healthy body, the elimination of immune complexes is carried out with the help of special cells. Violation of this process leads to an excessive accumulation of circulating immune complexes and their deposition in the microvasculature, which causes a secondary inflammatory change in the vascular wall. This inflammatory process causes an increase in the permeability of the vascular wall and the deposition of thrombotic masses in the lumen of the vessels.

At the same time, blood clots and extravasases occur, i.e. protrusions of blood from the vessel, which are the main signs of the disease. Moreover, the vessels of any organs and parts of the body - the lungs, kidneys, brain and its membranes can be involved in the pathological process.

In nearly 80% of patients, the development of pathology is preceded by an infectious disease of the upper respiratory tract. There are cases of illness after typhoid, jaundice, and measles. Factors that increase the likelihood of this disease may also be:

  • food allergies;
  • some drugs;
  • insect bites;
  • hypothermia;
  • vaccine administration;
  • tendency to allergic reactions.

Many doctors adhere to the assumption that the influence of these factors leads to the development of the disease only in the presence of a genetic predisposition of the organism.

Men and women get sick with the same frequency, and in summer the incidence is much lower. The course of the disease can be acute, wavy and recurrent.

Classification

In accordance with the clinical course, the following forms of the disease are distinguished:

  • dermal or simple;
  • abdominal;
  • articular;
  • renal;
  • fast flowing;
  • combined

All of these syndromes of varying severity can be combined with each other. The most common skin-joint option, which is referred to as simple.

The disease is also classified depending on the severity of its occurrence - emit a form of mild severity, moderate and severe.

By the nature of the flow, hemorrhagic vasculitis is distinguished:

  • acute, lasting up to 2 months;
  • protracted, lasting up to six months;
  • chronic.



Symptoms of hemorrhagic vasculitis

Manifestations of the disease depend on which organs and systems are covered. A disease may manifest itself as one or more groups of symptoms. Major of the following:

  • skin lesions;
  • joint damage;
  • lesions of the gastrointestinal tract;
  • renal syndrome;
  • in rare cases - lesions of the lungs and nervous system.

The most characteristic is the acute onset of the disease, accompanied by a rise in temperature to febrile numbers. There may be cases where the temperature rise is absent.

Among the diagnostic criteria of the disease are its skin manifestations. A typical hemorrhagic rash or so-called palpable purpura slightly rises above the surface of the skin. Its individual elements can merge, forming areas of significant area.

At the onset of the disease, the site of localization of lesions is the distal parts of the lower limbs. Then they gradually spread to the hips and buttocks. Very rarely, rashes are covered by the upper limbs, the abdomen or the back. A few days after the appearance of purple pales, takes on a brown color and gradually disappears. Pigmentation sites may persist for some time during a relapsing course. Characteristic is the absence of scars.

Articular syndrome is often observed simultaneously with the skin, most characteristic of it for adults. Most often large leg joints are covered by the process, most rarely - elbow and wrist wrist. Marked pain, redness and swelling. Typical of hemorrhagic vasculitis is the volatile nature of the articular lesions. In 25% of cases, migrating joint pains precede skin lesions.

Articular syndrome, which seldom lasts a week in duration, is sometimes combined with myalgia and lower extremity edema.

In 2/3 of patients, abdominal syndrome is also observed. It is characterized by abdominal pains of a spastic nature, nausea, vomiting, gastric bleeding. At the same time, truly life-threatening phenomena are observed in only 5% of patients.

Kidney damage is less common than other manifestations of the disease and occurs in about 30% of cases of the disease. At the same time, the intensity of the renal symptoms can vary from rapidly disappearing with the start of treatment to pronounced glomerulonephritis. Kidney damage can be called the most persistent disease syndrome, which sometimes leads to renal failure and even death.

In isolated cases, there are pulmonary complaints - bleeding, hemorrhage. Also rarely there are lesions of the nervous system - headaches, convulsions , may develop encephalopathy or polyneuropathy.

Features in children

The disease can break out at any age, but children under 3 years old rarely get sick. The greatest number of cases of hemorrhagic vasculitis is noted at the age of 4 to 12 years.

The features of its course in children are:

  • acute onset of the disease;
  • pronounced exudative component;
  • limited angioedema;
  • propensity to generalize the process;
  • the presence of abdominal syndrome;
  • propensity to relapse.

In children, hemorrhagic vasculitis is often caused by hypothermia or a serious viral disease. The disease is more often characterized by fulminant course.

In this disease, children more often than adults have systolic heart murmurs of a functional nature. In boys with hemorrhagic vasculitis, bilateral testicular lesions are observed in some cases. In half the cases, children may be completely absent skin manifestations.

Children who have had hemorrhagic vasculitis are observed by the doctor for another 5 years. They are recommended hypoallergenic diet throughout the year. If the disease has a renal impairment, then such an observation should continue until adulthood. Such children are not subjected to vaccination over the next 3-5 years.

Diagnostics

For the diagnosis, the classification criteria of this disease are used, recognized by the international community of rheumatologists for many years:

  • presence of palpable purpura;
  • age at which the onset of the disease, less than 20 years;
  • the presence of pain in the abdomen;
  • during biopsy granulocyte detection.

Confirm the diagnosis allows the presence in a patient of 2 or more of these criteria. It is taken out on the basis of clinical data, laboratory values ​​are not important. Although doctors and pay attention to the amount of ESR and the level of leukocytes in the blood, these figures do not specifically indicate this disease, but they say only that there is an inflammatory process.

With the development of renal syndrome, consultation of a nephrologist and a number of studies of the kidneys - ultrasound and ultrasound of renal vessels are required.

The abdominal form of the disease requires differential diagnosis with other pathologies that give a picture of the "acute abdomen." This requires consultation with the surgeon, abdominal ultrasound and gastroscopy.

It is most easy to diagnose a disease when rash appears. In the most severe diagnostic cases, a skin biopsy is recommended.

Treatment of hemorrhagic vasculitis

Treatment of hemorrhagic vasculitis is carried out in a hypoallergenic diet and strict bed rest. Canceled drugs that could cause the onset of the disease. Restriction of motor activity, i.e. bed rest is sometimes necessary for 3-4 weeks. In case of its violations, a repeated wave of lesions, qualified as orthostatic purpura, is possible.

Drug basic therapy provides for strictly individual use of drugs in the following groups:

  • antiplatelet agents;
  • anticoagulants;
  • antihistamines;
  • antibacterial therapy;
  • infusion therapy;
  • glucocorticoids;
  • cytostatics.

In all forms of this disease, antiplatelet agents are prescribed. Curantil, Trental or their analogues are commonly used. In severe cases, prescribe two drugs at the same time.

Anticoagulants, among which Heparin is most often used, are also indicated for all clinical forms, they are prescribed in individually selected doses.

Antihistamines are effective in patients suffering from allergic diseases or manifestations of exudative-catarrhal diathesis. Assign Tavegil, Diazolin, Suprastin.

Non-steroidal anti-inflammatory drugs are also used in hemorrhagic vasculitis. They limit the development of exudative and proliferative stages of inflammation. The most pronounced anti-inflammatory effect has Ortofen, which is prescribed in a daily dose of 1 to 2 mg / kg for 4-6 weeks.

When a continuously recurring wave-like course of the disease, with the development of infection or exacerbation of chronic, antibacterial therapy is used with the appointment of antibiotics of the new generation - Sumamed, Klacida, etc.

With rapid forms of the disease, the presence of high ESR, cryoglobulinemia is effective plasmapheresis with transfusion of donor plasma. In severe cases, therapy is carried out with glucocorticosteroids, which helps reduce swelling, pain in the joints and abdomen. Unfortunately, it is not very effective for skin and kidney damage. Prednisolone is prescribed most often in a daily dose of 2 mg / kg. The duration of application and the withdrawal scheme depends on the clinical form of the disease.

As an auxiliary prescribed means of external use. These are usually ointments designed to restore the elasticity of blood vessels. These include Solcoseryl, Atsemin ointment. At occurrence of erosive and ulcerative skin lesions, ointments with epithelizing properties of Vishnevsky, Mikulich, Solkoseril are prescribed.

The duration of treatment of hemorrhagic vasculitis depends on the severity of the disease and on its clinical form. But even with a light current it will take 2-3 months, with a severe recurrent - up to 12 months.

Diet

It is very important during the treatment to prevent additional sensitization of the patient. Therefore, a diet that excludes extractives, chocolate, coffee, citrus, strawberries, eggs, industrial canned food, and products that are poorly tolerated by the patient, is required.

Special diets are prescribed in addition to pronounced abdominal or renal syndromes. So, in case of heavy nephritis it is recommended to follow diet No. 7 without salt and meat.

Forecast

The mildest forms of the disease are prone to spontaneous healing after the first attack. In most cases, the symptoms disappear 5-6 weeks after the onset of the acute stage of the disease.

In the acute period, the most dangerous complication is renal failure. With rapidly progressive glomerulonephritis, the prognosis is unfavorable. In rare cases, death can also occur as a result of gastrointestinal bleeding, invagination or intestinal infarction, as well as due to damage to the central nervous system and the development of intracerebral hemorrhage.

A fatal outcome, which can occur literally in the first few days of the onset, is also possible with the fulminant form of the disease.


| 15 May 2015 | | 1,375 | Joint diseases
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Muhammad Ali: a humble suggestion if you can include case scenarios at that end it ll be awesome. Very well prepared, to the point , recommended for revision. mneumonic { JOIN (joint) GIDDY ( vomiting diarrhoea anaemic) KID ( nephrotic and nephritic si/sx) JOIN GIDDY KID DISEASE

Kh Zeynep: I had this disease 3years ago and it lasted about 6months. It was horrible and I was banned from eating chocolate and any other food,even a salt....

Princess Vane: I have this disease and it frustrate me all the time 😭 2yrs have passed till now i have it 😭 i want to go back to my normal life again!

nigel weir: Am 39 and I have it at the moment not good just don't feel good at all and in pain sometimes am a bit worried about it as I have gout as well.

Our Family's Memories: God healed my son from allergic Purpura last year!! He had 105 fevers every night, hives looking rash all over his body, swelling in his joints, purple behind his knees, blood in his stool, he was having borderline kidney failure, pain in his stomach it was BAD! I started a 3 day fast on behalf of my son. I had never done a 3 day fast because I thought I would die. But my need was great and God’s power was GREATER!! He got me through the fast and right on the third day when I was ending my water only fast God healed my son and everything went away at once and it never came back since that day!! His pediatrician kept testing his kidneys and every time the test results came back great! My son God healed by the blood of Jesus! Because Jesus already paid for our infirmities on the cross when He she’s His powerful blood! Seek God in your need HE IS FAITHFUL 🙌🏼❤️

Suga Sweg: I had it in 6th grade. It was very painful since I had the worst form. I had to go to a very special hospital called NYU longouge to cure it. Though I'm good now but it left marks on me ;c

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