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Other namesVasculitides[1]
Petechia and purpura on the lower limb due to medication-induced vasculitis
SpecialtyRheumatology, Immunology
SymptomsWeight loss, fever, myalgia, purpura
ComplicationsGangrene, Myocardial infarction

Vasculitis is a group of disorders that destroy blood vessels by inflammation.[2] Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis.[3] Vasculitis is primarily caused by leukocyte migration and resultant damage. Although both occur in vasculitis, inflammation of veins (phlebitis) or arteries (arteritis) on their own are separate entities.

Signs and symptoms[edit]

Possible signs and symptoms include:[4] [5]



Vasculitis can be classified by the cause, the location, the type of vessel or the size of vessel.

  • Underlying cause. For example, the cause of syphilitic aortitis is infectious (aortitis simply refers to inflammation of the aorta, which is an artery.) However, the causes of many forms of vasculitis are poorly understood. There is usually an immune component, but the trigger is often not identified. In these cases, the antibody found is sometimes used in classification, as in ANCA-associated vasculitides. Clinical studies with immunosuppressive drugs targeting specific cytokines and cells can also be used to understand the heterogeneous immunopathogenic mechanisms of vasculitis and support a mechanistic immunological classification.[6]
  • Location of the affected vessels. For example, ICD-10 classifies "vasculitis limited to skin" with skin conditions (under "L"), and "necrotizing vasculopathies" (corresponding to systemic vasculitis) with musculoskeletal system and connective tissue conditions (under "M"). Arteritis/phlebitis on their own are classified with circulatory conditions (under "I").
  • Type or size of the blood vessels that they predominantly affect.[7] Apart from the arteritis/phlebitis distinction mentioned above, vasculitis is often classified by the caliber of the vessel affected. However, there can be some variation in the size of the vessels affected.

A small number have been shown to have a genetic basis. These include adenosine deaminase 2 deficiency and haploinsufficiency of A20.

According to the size of the vessel affected, vasculitis can be classified into:[8][9]

Comparison of major types of vasculitis
Vasculitis Affected organs Histopathology
Cutaneous small-vessel vasculitis Skin, kidneys Neutrophils, fibrinoid necrosis
Granulomatosis with polyangiitis Nose, lungs, kidneys Neutrophils, giant cells
Eosinophilic granulomatosis with polyangiitis Lungs, kidneys, heart, skin Histiocytes, eosinophils
Behçet's disease Commonly sinuses, brain, eyes and skin; can affect other organs such as lungs, kidneys, joints Lymphocytes, macrophages, neutrophils
Kawasaki disease Skin, heart, mouth, eyes Lymphocytes, endothelial necrosis
Buerger's disease Leg arteries and veins (gangrene) Neutrophils, granulomas
"Limited" granulomatosis with polyangiitis vasculitis Commonly sinuses, brain, and skin; can affect other organs such as lungs, kidneys, joints;

Takayasu's arteritis, polyarteritis nodosa and giant cell arteritis mainly involve arteries and are thus sometimes classed specifically under arteritis.

There are also many conditions that have vasculitis as an accompanying or atypical feature, including:

In pediatric patients, varicella inflammation may be followed by vasculitis of intracranial vessels. This condition is called post-varicella angiopathy and may be responsible for arterial ischaemic strokes in children.[13]

Several of these vasculitides are associated with antineutrophil cytoplasmic antibodies.[14] These are:


Micrograph showing a vasculitis (eosinophilic granulomatosis with polyangiitis). H&E stain.
Severe vasculitis of the major vessels, displayed on FDG-PET/CT
  • Some types of vasculitis display leukocytoclasis, which is vascular damage caused by nuclear debris from infiltrating neutrophils.[15] It typically presents as palpable purpura.[15] Conditions with leucocytoclasis mainly include hypersensitivity vasculitis (also called leukocytoclastic vasculitis) and cutaneous small-vessel vasculitis (also called cutaneous leukocytoclastic angiitis).
  • An alternative to biopsy can be an angiogram (x-ray test of the blood vessels). It can demonstrate characteristic patterns of inflammation in affected blood vessels.
  • 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)has become a widely used imaging tool in patients with suspected Large Vessel Vasculitis, due to the enhanced glucose metabolism of inflamed vessel walls.[16] The combined evaluation of the intensity and the extension of FDG vessel uptake at diagnosis can predict the clinical course of the disease, separating patients with favourable or complicated progress.[17]
  • Acute onset of vasculitis-like symptoms in small children or babies may instead be the life-threatening purpura fulminans, usually associated with severe infection.
Laboratory Investigation of Vasculitic Syndromes[18]
Disease Serologic test Antigen Associated laboratory features
Systemic lupus erythematosus ANA including antibodies to dsDNA and ENA [including SM, Ro (SSA), La (SSB), and RNP] Nuclear antigens Leukopenia, thrombocytopenia, Coombs' test, complement activation: low serum concentrations of C3 and C4, positive immunofluorescence using Crithidia luciliae as substrate, antiphospholipid antibodies (i.e. anticardiolipin, lupus anticoagulant, false-positive VDRL)
Goodpasture's disease Anti-glomerular basement membrane antibody Epitope on noncollagen domain of type IV collagen
Small vessel vasculitis
Microscopic polyangiitis Perinuclear antineutrophil cytoplasmic antibody Myeloperoxidase Elevated CRP
Granulomatosis with polyangiiitis Cytoplasmic antineutrophil cytoplasmic antibody Proteinase 3 (PR3) Elevated CRP
Eosinophilic granulomatosis with polyangiitis perinuclear antineutrophil cytoplasmic antibody in some cases Myeloperoxidase Elevated CRP and eosinophilia
IgA vasculitis (Henoch-Schönlein purpura) None
Cryoglobulinemia Cryoglobulins, rheumatoid factor, complement components, hepatitis C
Medium vessel vasculitis
Classical polyarteritis nodosa None Elevated CRP and eosinophilia
Kawasaki's Disease None Elevated CRP and ESR

In this table: ANA = antinuclear antibodies, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, dsDNA = double-stranded DNA, ENA = extractable nuclear antigens, RNP = ribonucleoproteins; VDRL = Venereal Disease Research Laboratory


Treatments are generally directed toward stopping the inflammation and suppressing the immune system. Typically, corticosteroids such as prednisone are used. Additionally, other immune suppression medications, such as cyclophosphamide and others, are considered. In case of an infection, antimicrobial agents including cephalexin may be prescribed. Affected organs (such as the heart or lungs) may require specific medical treatment intended to improve their function during the active phase of the disease.[citation needed]


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  2. ^ "Glossary of dermatopathological terms. DermNet NZ". Archived from the original on 20 December 2008. Retrieved 8 January 2009.
  3. ^ "Vasculitis" at Dorland's Medical Dictionary
  4. ^ "The Johns Hopkins Vasculitis Center - Symptoms of Vasculitis". Archived from the original on 27 February 2009. Retrieved 7 May 2009.
  5. ^ "Vasculitis - Symptoms | NHLBI, NIH". 22 May 2023. Retrieved 23 October 2023.
  6. ^ Torp, Christopher Kirkegaard; Brüner, Mads; Keller, Kresten Krarup; Brouwer, Elisabeth; Hauge, Ellen-Margrethe; McGonagle, Dennis; Kragstrup, Tue Wenzel (2021). "Vasculitis therapy refines vasculitis mechanistic classification". Autoimmunity Reviews. 20 (6): 102829. doi:10.1016/j.autrev.2021.102829. PMID 33872767.
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  8. ^ "Overview of Vasculitis". Merck Manuals Professional Edition. Archived from the original on 3 April 2015. Retrieved 5 October 2016.
  9. ^ Gündüz, Özgür (18 October 2011). "Histopathological Evaluation of Behçet's Disease and Identification of New Skin Lesions". Pathology Research International. 2012: 209316. doi:10.1155/2012/209316. ISSN 2090-8091. PMC 3199096. PMID 22028988.
  10. ^ Meyts, Isabelle; Aksentijevich, Ivona (July 2018). "Deficiency of Adenosine Deaminase 2 (DADA2): Updates on the Phenotype, Genetics, Pathogenesis, and Treatment". Journal of Clinical Immunology. 38 (5): 569–578. doi:10.1007/s10875-018-0525-8. ISSN 0271-9142. PMC 6061100. PMID 29951947.
  11. ^ Donadieu, Jean; Lamant, Marie; Fieschi, Claire; de Fontbrune, Flore Sicre; Caye, Aurélie; Ouachee, Marie; Beaupain, Blandine; Bustamante, Jacinta; Poirel, Hélène A.; Isidor, Bertrand; Van Den Neste, Eric (August 2018). "Natural history of GATA2 deficiency in a survey of 79 French and Belgian patients". Haematologica. 103 (8): 1278–1287. doi:10.3324/haematol.2017.181909. ISSN 0390-6078. PMC 6068047. PMID 29724903.
  12. ^ Geier, Christoph B.; Farmer, Jocelyn R.; Foldvari, Zsofia; Ujhazi, Boglarka; Steininger, Jolanda; Sleasman, John W.; Parikh, Suhag; Dilley, Meredith A.; Pai, Sung-Yun; Henderson, Lauren; Hazen, Melissa (21 October 2020). "Vasculitis as a Major Morbidity Factor in Patients With Partial RAG Deficiency". Frontiers in Immunology. 11: 574738. doi:10.3389/fimmu.2020.574738. ISSN 1664-3224. PMC 7609967. PMID 33193364.
  13. ^ Nita R Sutay, Md Ashfaque Tinmaswala, Shilpa Hegde . "International Journal of Medical Research and Health Sciences | 404 Page". Archived from the original on 17 November 2015. Retrieved 19 August 2015.
  14. ^ Millet A, Pederzoli-Ribeil M, Guillevin L, Witko-Sarsat V, Mouthon L (2013) Antineutrophil cytoplasmic antibody-associated vasculitides: is it time to split up the group? Ann Rheum Dis
  15. ^ a b A Brooke W Eastham, Ruth Ann Vleugels and Jeffrey P Callen (12 July 2021). "Leukocytoclastic Vasculitis". Medscape. Updated: Oct 25, 2018
  16. ^ Maffioli L, Mazzone A (2014). "Giant-Cell Arteritis and Polymyalgia Rheumatica". NEJM. 371 (17): 1652–1653. doi:10.1056/NEJMc1409206. PMC 4277693. PMID 25337761.
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External links[edit]