Vasculitis hemorrhagic

Vasculitis hemorrhagic (anaphylactic purpura, capillarotoxicosis, Shenlaine-Henoch disease). The etiology is not completely clear. Causes are acute and chronic infections, toxic-allergic factors (eggs, fish, milk, vaccinations, some drugs, helminths).

Pathogenesis is complicated. Attention is given to the formation of toxic substances that affect the walls of blood vessels, increasing their permeability. A definite role is assigned to immunocomplex lesions of the vascular wall (detection of immunoglobulins A, M, G, fibrinogen, C, -complete in the skin and wall of the vessels) and immunodeficiency state (C2-complement deficiency).

Clinical picture. The disease often begins suddenly, less often after a brief prodromal period (cognition, headache, malaise), usually after the infection (influenza, angina, etc.). An important symptom is skin lesions in the form of papular-hemorrhagic, sometimes bullous rash. Skin eruptions are symmetrical, localized mainly on the legs around the joints, although they can be on the trunk, buttocks, face (cheeks, nose, ears), hands; Characterized by distal arrangement. After the disappearance of the rash, pigmentation remains on the skin. Often there are pruritus, paresthesia. Often, along with purpura, children have swelling of the hands, feet, and legs of the Quincke edema type. Body temperature in most patients is elevated to subfebrile digits.

The presence of hematuria indicates the attachment of hemorrhagic nephritis. A frequent symptom with purpura is abdominal pain, vomiting is possible with an admixture of blood, black stools. Pain in the joints and their swelling are noted. At laboratory researches neutrophilic leukocytosis with a shift to the left, eosinophilia is marked; The albumin-globulin index is reduced the stronger, the heavier the disease, the amount of prothrombin is lowered, the permeability of capillaries is increased. Children of preschool age are more often ill. Duration of the disease from 2-3 weeks to several years. There are acute (up to 30-40 days), subacute (within 2 months and more), chronic (clinical symptoms persist up to 1.5-5 years and more) and recurrent course (relapses up to 3-4 times or more for 3 -5 years and more), and also 3 degrees of activity: I degree (minimal), II degree, at which the exudative component is expressed distinctly, and III degree (abundant exudative hemorrhagic rash, often with vesicular necrotic elements, polyarthritis, changing their localization recurring Angioedema, severe abdominal syndrome with bloody vomiting and bloody stool, damage to the kidneys, blood vessels of the liver, eye membranes, nervous, cardiovascular system).

It is necessary to differentiate from the disease of Verlhof and hemophilia. Treatment. It is important to comply with bed rest not only in the acute period of the disease, but also within 1-2 weeks after the disappearance of the rash. In those cases when an association with the infection is established, broad-spectrum antibiotics are used. For the purpose of hyposensitization, dimedrol, suprastin and other antihistamines are prescribed. As anti-inflammatory drugs prescribe salicylates, amidopyrine, analgin. Carboline is used as a means of adsorbing histamine-like substances in the intestine. To reduce the permeability of the vessel wall, 10% calcium chloride solution, vitamin C, rutin is used. In severe cases with abdominal, renal and cerebral syndromes, hormone therapy (prednisolone) has a good effect, in very severe cases heparin is used. The prognosis is generally favorable, but becomes serious with the development of abdominal, renal or cerebral syndrome.