Hemorrhagic vasculitis

Hemorrhagic vasculitis ( Shenlaine-Henoch disease) is a systemic lesion of capillaries, arterioles, venules, mainly of the skin, joints, abdomen and kidneys.

Etiology. The disease usually occurs in children and adolescents, less often in adults of both sexes after a previous infection - streptococcal angina or exacerbation of tonsillitis, pharyngitis, and after the introduction of vaccines and serums, due to drug intolerance, cooling and other adverse effects of the external environment.

Pathogenesis is associated with immune disorders - an increase in the level of circulating immune complexes with which the vascular wall is associated, which leads to an increase in their permeability, edema and purpura of different localization.

Symptoms, course. The disease is often manifested in a triad: small-red, sometimes merging hemorrhagic skin rashes (purpura), transient arthralgia (or arthritis), mostly large joints, and abdominal syndrome. The initial skin rashes are located on the extensor surfaces of the limbs, sometimes on the trunk, ending with residual pigmentation, which can remain for a long time. Most often the lower extremities are affected. Skin rashes can be the only manifestation of the disease.

Migrating symmetrical polyarthritis, usually large joints, are observed in more than 2/3 of patients, accompanied by pain of a different nature - from short-term aches to acute, leading patients to immobility. Arthritis often coincides with the appearance and localization of purpura.

Abdominal syndrome (abdominal purpura) is characterized by a sudden development of intestinal colic. The pain is usually localized around the navel, but often in other parts of the abdomen (right iliac region, right hypochondrium, epigastrium), simulating appendicitis, cholecystitis, pancreatitis. Pain is worse with palpation. At the same time, a typical picture of the abdominal syndrome is observed in the ballroom - the pallor of the skin, the sagging face, sunken eyes, pointed facial features, dry tongue, signs of irritation of the peritoneum. Patients usually lie on their sides, pressing their legs to the stomach, rush. Simultaneously with colic there are bloody vomiting, loose stools often with veins of blood. All varieties of abdominal purpura can be placed in the following options: typical colic, abdominal syndrome, simulating appendicitis or perforation of the intestines, abdominal syndrome with intussusception. This list of options determines the tactics of joint observation by therapists and surgeons, the need for timely surgery (intestinal perforation, intussusception).

Often, the pathological process involves kidneys in the form of hematuric glomerulonephritis due to the defeat of glomerular capillaries. However, at the end of glomerulonephritis, chronic renal pathology can be diverse - from a urinary syndrome to a diffuse glomerulonephritis of the hypertonic or mixed type. With the general favorable course of jade, outcomes in chronic progressive nephritis with renal insufficiency are possible.

Other clinical signs (CNS damage, hemorrhagic pneumonia, myocarditis and serositis) are rare and are recognized in special studies. The laboratory data are of little character - usually leukocytosis is most pronounced in the abdominal syndrome, with a shift of the formula to the left up to young ESR is usually increased, especially with abdominal syndrome and polyarthritis.

In acute course, the disease begins suddenly and flows violently with the multi-symptomatic clinic of the disease, often complicated by nephritis. In chronic course, for the most part, it is a recurrent skin-joint syndrome (orthostatic purpura of the elderly). The diagnosis in the presence of a characteristic triad or only hemorrhagic rashes on the skin does not cause difficulties. However, the syndrome of hemorrhagic vasculitis can occur with infective endocarditis, various vasculitis, diffuse connective tissue diseases, etc. In elderly people, it is necessary to exclude the Waldenstrom macroglobulinemic purpura. Treatment. Prescribe antihistamines and anti-inflammatory drugs in conventional doses. In the acute period of the disease, a strict bed rest is needed. In severe cases, heparin is prescribed (10 000 - 1 5 000 ED) 2 times in the abdomen before the elimination of signs of hypercoagulability. With abdominal syndrome, the introduction of large doses of methylprednisolone in doses of up to 1 g per day for 3 days is shown. In chronic course, aminoquinoline preparations, large doses of ascorbic acid (up to 3 g / day), rutin can be recommended. With focal infection shown sanation - conservative or surgical. Some patients with a chronic recurrent course of cutaneous purpura or glomerulonephritis can be recommended for climatotherapy (southern Ukraine, Southern coast of Crimea, Northern Caucasus).