PATHOPHYSIOLOGY OF VASCULITIDES VASCULITIDES Giant Cell Arteritis SIZE OF VESSEL Large (aorta + major braci, carotid, subclavi an)

) Large AGE >50 SEX Male SITE - Temporal arteries - Cranial arteries - Aortic arch PRESENTATION & MORPHOLOGY - Artery is cord- like and nodular - Thrombus in lumen - Granulomatous inflamm. of arterial wall SYMPTOMS - blurring of vision - double vision - blindness - temporal headaches

Takayasus Arteritis (auto-immune)

15-40

Female

- Aortic arch and its major branches

- Intimal thickening, obliteration of lumen - Intense mononuclear inflammation in adventitia

- pulseless disease (due to narrowing of aortic arch) - ocular disturbances - hypertension - various neurologic defects

A. Narrowing of brachiocephalic, Carotid and subclavian artery B. Gross- intimal thickening with Minimal residual lumen

C. Histology- destruction of arterial Media by mononuclear inflamm. With giant cells Polyarteritis Nodosa Medium Young - Medium and Smaller muscular Arteries - Renal and visceral Vessels (coronary, Hepatic, mesenteric) Sparing the pulmonary - Patchy involvement of arteries Predilection for branching points - Absent small vessel involvement, No glomerulonephritis - Association with Hepatitis B - FUO - Weight loss - Hypertension - Abdominal pain & melaena - Peripheral neuritis

Active PAN with inflammation and fibrinoid necrosis of arterial walls

Extensive infiltrate to be composed of polymorphonuclear leukocytes. The vascular involvement is fully circumferential.

Segmental fibrinoid necrosis and thrombotic occlusion of the lumen of this small artery Kawasaki Disease (Muco-cutaneous LN syndrome) Medium Infancy & childhood - Necrotizing vasculitis resembling PAN (polyarthritis nodosa) - Fever - Skin rash - Conjunctival - Oral lesions - Enlarged cervical lymph nodes - When develop in CV sequelae Coronary artery aneurysms

Microscopic polyangitiis

Small

- Arterioles - Capillaries - Venules Elderly Male - Nasal sinuses - Nasopharynx - Lungs (focal necrotizing Vaculitis + acute Necrotizing granuloma) - Kidneys

- Cutaneous lesions Leukocytoclastic vasculitis - Systemoc lesions Microscopic polyarteritis - Persistent sinusitis - Pneumonitis - Hematuria - Proteinuria - Renal failure - Skin rash - Muscle pain - Articular environment - Polyneuritis - Fever

Wegeners Granulomatosis

Small

Multinucleated giant cells and

spindle shaped macrophages to form a characteristic palisading granuloma Thrombo-Angitis Obliterans / Buergers Disease Small <35 Male - Small arteries and (smoker) veins Of extremities - Neutrophil inflammation of all Coats of vessel wall together with Occlusive thrombosis. - Small microabscesses within Thrombus - Organisation & recanalization of thrombus - Superficial nodular phlebitis - Raynauds phenomena - Intermittent claudication - Ultimately gangrene of extremities