Wegener's granulomatosis: case report and literature review

Childhood cutaneous vasculitis: a comprehensive appraisal

Cutaneous vasculitides in childhood are rare and often present with clinical features distinct from adults. Diagnosis of cutaneous vasculitides in children was difficult because of lack of a satisfactory classification systems for this age group. A new international classification system for childhood vasculitis has been discussed in the following section along with important clinical features, diagnostic modalities, and recent therapeutic developments of important vasculitides in children.

Angiocentric lesions of the head and neck

Angiocentric lesions of the head and neck encompass a variety of benign and malignant lesions. Not unexpectedly the sequelae of an angiocentric process independent of its benign or malignant nature is one of tissue ischemia with a potential for either breakdown or reparative fibrosis. Therefore, the clinical presentations can be very similar despite a varied pathogenesis. Among the benign reactive infiltrates that will be considered are angiocentric eosinophilic fibrosis, Wegener's granulomatosis, microscopic polyangiitis and cocaine associated mid line facial destruction. We will discuss other conditions which enter into the differential diagnosis either clinically or histologically including Erdheim Chester disease and mid line facial undermining unrelated to an angiocentric event specifically in the context of trigeminal trophic ulcer and relapsing polychondritis. The two main neoplastic conditions exhibiting angiocentricity are in the context of lymphomatoid granulomatosis and NK/T cell lymphoma; hence these two particular hematologic dyscrasias will be discussed in some detail in this review.

Wegener?s granulomatosis: Symptoms, diagnosis, and treatment

PURPOSE

To provide nurse practitioners with a basic understanding of the clinical presentation, diagnosis, diagnostic testing, pharmacological treatment, and prevalence of Wegener's granulomatosis (WG).

DATA SOURCES

Published research and clinical articles, and a case report.

CONCLUSIONS

WG is a systemic disease characterized by vasculitis, necrosis, and granulomas. The diagnosis of WG is difficult, particularly early in the disease process. In order to confirm the diagnosis, the patient should undergo specific tests such as antineutrophil cytoplasm antibodies, erythrocyte sedimentation rate, C-reactive protein, and biopsy of the tissue involved.

IMPLICATIONS FOR PRACTICE

The diagnosis of WG is often delayed because of the vague symptoms on presentation. Initial symptoms, such as chronic fatigue, upper respiratory infection, sinusitis, and otitis media are common and may not be alarming. Recognizing symptoms, ordering diagnostic tests, and providing appropriate pharmacological therapy is key to diagnosing and treating WG.

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

A broad and diverse spectrum of vasculitic syndromes exists. These syndromes affect the skin with varying levels of associated systemic manifestations, running the gamut from a self-limited, localized, cutaneous phenomenon to rapidly progressive, multiorgan disease. The majority of cases of cutaneous vasculitis will show a neutrophilic small vessel vasculitis that can be either a primary (idiopathic) disorder (eg, cutaneous leukocytoclastic angiitis) or a secondary disorder that is associated with drugs, infection (eg, streptococcal infection, viral hepatitis), or underlying disease (eg, connective tissue disease, malignancy). Biopsy is the gold standard for the diagnosis of cutaneous vasculitis and also necessary for the detection of cutaneous vascular immune complexes by direct immunofluorescence. Based on the type of vessel disrupted by inflammation (small and/or muscular), the distribution of vasculitis in the dermis and subcutis, and predominate inflammatory cell-type mediating vessel wall damage, a list of relevant differential diagnoses can be generated. This histologic information coupled with extravascular findings such as tissue eosinophilia, tissue neutrophilia, and/or granulomas, plus pathophysiologic markers such as direct immunofluorescent examination for immune complexes and serologic evaluation for antineutrophil cytoplasmic antibodies allows for more accurate diagnosis of specific vasculitic entities. Herein, we review both primary and secondary vasculitic syndromes that affect the skin and show a small vessel neutrophilic mediated vasculitis.

Wegener's granulomatosis: a rare, chronic and multisystem disease

Wegener's granulomatosis (WG) is an autoimmune disease which has a clinical predilection for the upper airways, lungs and kidneys. It is a necrotising granulomatous vasculitis which is associated with a distinct autoantibody--the antineutrophil cytoplasmic antibody (ANCA). A heightened index of suspicion by clinicians is needed in the diagnosis of this complex and rare condition. A multidisciplinary approach should then be used to treat this chronic multisystem disease. Treatment involves the use of various regimens of corticosteroids and immunosuppressive medication. Mortality due to WG has been significantly decreased by this therapy. In this article, we focus on clinical manifestations and review the salient histologic, laboratory and serologic features and treatment.

Plasmapheresis by using secondary membrane filters: twelve years of experience

Over 1,600 plasmapheresis procedures have been performed by using secondary on-line membrane plasma filters in 62 patients over the past 12 years in our institution. The disease categories treated include cryoprotein induced diseases such as cryoglobulinemia, immune mediated disorders, and familial type II-A hypercholesterolemia (FHC). Depending upon the molecular size of the offending agent, we used plasma filters (PF) with different pore sizes ranging from 0.02 microm to 0.04 microm or the cryoglobulin filter (CF) with an average pore size of 4.3 microm to remove cryoprecipitable proteins. One plasma volume was processed in each treatment. The results of treating 25 patient in over 550 procedures by using PF show it is safe and effective in treating immune mediated disorders and FHC. PF selectively removes macromolecules according to pore size and are more specific for the treatment of immune mediated diseases and FHC than plasma exchange. The results of treating 37 patients in over 1,100 procedures by using CF show it is safe and effective in selectively removing cryoproteins, and it is very specific for the treatment of cryoprotein induced diseases. Both PF and CF are biocompatible, with no complement activation. Unlike plasma exchange, secondary membrane plasma filters do not cause deficiency syndromes and do not require albumin or fresh frozen plasma as replacement fluid, making them more cost effective than plasma exchange.