Hemorrhagic vasculitis is a pathology that is a type of immune vasculitis. This disease affects small blood vessels. It is characterized by an increase in the formation of immune complexes, an increase in permeability and a decrease in the elasticity of arterial and capillary walls.
The disease often occurs 10-20 days after acute respiratory infections, tonsillitis, influenza or scarlet fever, so children are at risk for this disease. Children aged 3 to 7 years are especially susceptible to pathology. By the way, boys get sick 2-3 times more often than girls. In the international classification of diseases of the 10th revision (ICD 10), hemorrhagic vasculitis was labeled D69.0, D89.1 - “Systemic hemorrhagic vascular lesions.”
Causes of disease
Why does an ailment occur, which is also called Henoch-Schonlein disease and capillary toxicosis? The mechanism of development of vasculitis is quite simple: an aseptic inflammatory process occurs in the capillaries, caused by the damaging effect of immune complexes.antibodies. Henoch-Schonlein disease is manifested by hemorrhages, a malfunction in the processes of intravascular coagulation and a violation of blood circulation in small arteries.
Causes of hemorrhagic vasculitis in patients of any age are conditionally divided into several categories:
- complications after an illness (respiratory viral infection, chickenpox, herpes, scarlet fever) caused by pathogenic microflora and parasites;
- allergic reactions;
- hypothermia;
- vaccine intolerance;
- hereditary predisposition.
The main factor in the occurrence of hemorrhagic vasculitis is the formation of immune complexes consisting of antibodies. These formations are deposited on the inner surface of the arterial walls, which cause microscopic damage to the vessels and, as a result, provide conditions for the development of post-traumatic aseptic inflammation. Accordingly, with inflammation of the vascular tissue, its elasticity decreases markedly, as a result of which the walls become permeable, gaps appear. This condition of the arteries and capillaries leads to fibrin deposits and the formation of blood clots. The above explains the appearance of symptoms of vasculitis - bruising, provoked by microthrombosis of blood vessels.
Varieties
Today, doctors know several forms of hemorrhagic vasculitis. Depending on the clinical picture, the disease happens:
- dermal;
- articular;
- abdominal, that is, developing in the abdominal cavity;
- renal;
- combined.
The disease can occur simultaneously in several forms. Among the most common combinations, cutaneous-articular vasculitis is the most common. Experts also call this form simple. Depending on the severity of the pathology, it is assigned the degree of low, medium and high activity. Another typology of hemorrhagic vasculitis is built according to the nature of the course of the disease. So, capillary toxicosis can be:
- lightning fast (to develop literally in a matter of days);
- acute (disease duration usually does not exceed 30-40 days);
- protracted (over 2 months);
- recurrent (symptoms of the disease recur several times over 3-4 years);
- chronic (the clinical picture remains unchanged for 1.5-2 years, remissions alternate with frequent or rare exacerbations).
Main signs of pathology
Speaking about the clinical manifestations of the described vascular pathology, it is worth noting that adults and children have the same symptoms of hemorrhagic vasculitis. At the same time, the features of the course of the disease may vary depending on age. Mostly the disease is manifested by patchy rashes on the epidermis. They are called skin hemorrhagic rash.
In the articular form of vasculitis, patients complain of pain in the ankle joints. This symptom occurs in seven out of tencases. With the abdominal form of hemorrhagic disease, its inevitable manifestation is a dull, aching pain in the abdomen.
With complicated hemorrhagic vasculitis in adults, the vessels of internal organs, including the kidneys, lungs, and brain, are often affected. The most favorable prognosis is given to patients in whom the disease occurs only with superficial manifestations in the form of a hemorrhagic rash.
Spots on the skin with vasculitis
As already noted, with any form of this disease, bruising is observed on the skin. The defeat of the epidermis is the main manifestation of hemorrhagic vasculitis. It occurs in absolutely all patients, regardless of the manifestation of additional symptoms. Skin rashes can occur both at the very beginning, in the first stages of the disease, and after some time, as the pathology progresses. The most characteristic is the appearance of purpura - small-spotted hemorrhages, palpable. Such a rash is symmetrical, consists of small (from 1 to 3 mm) nodules. At first, the rash affects the feet and lower legs, but later spreads to the entire limb. In addition to purpura, other elements may also appear (vesicles, redness with peeling, and in severe cases even necrotic areas of the upper layer of the epidermis).
Joint pain
70% of case histories show the severity of such symptoms of vasculitis as joint pain. This sign often appears along with rashes in the first weeks of illness. Changes in the articular surfaces and internal sections may be accompanied by minor andshort painful sensations, however, a more extensive lesion is not excluded, in which not only the large (ankle and knee), but also the joints of the toes suffer. They swell, and a short-term change in their shape is also possible. However, with a normal course and timely therapy, the disease does not cause severe deformation of the articular surfaces, and discomfort does not bother on average for more than 5 days.
Gastrointestinal tract injury
The severity of the course is characterized by hemorrhagic vasculitis in adults, which is accompanied by damage to the vessels of the gastrointestinal tract. Often, the appearance of abdominal pain is ahead of a hemorrhagic rash. Unpleasant sensations occur when small capillaries break on the walls of the intestine, and therefore are of an acute cramping nature. Patients, describing discomfort, note that it mainly occurs in the umbilical, right iliac and hypochondral regions.
Pain syndrome in hemorrhagic vasculitis resembles the clinical picture caused by appendicitis, ulcer perforation or intestinal obstruction. The pain may last for 3-10 days. Often the disease occurs with nausea and vomiting, in which mucus and bloody impurities are present. By the way, blood in the feces with abdominal vasculitis is a very common symptom. In severe cases, intestinal bleeding develops, resulting in a sharp drop in blood pressure and collapse.
How the disease progresses at different ages
Differences in the course of the disease in children and adults lie in its development. In adults, the clinical picture is "blurred". For this reason, in the initial stages, the diagnosis of hemorrhagic vasculitis is difficult, since the symptoms are not fully manifested. The general well-being of the patient practically does not suffer.
In children, the pathology of small vessels has an acute onset. Vasculitis in children under 6 years of age develops rapidly, accompanied by fever, chills and weakness. At the same time, in half of the clinical cases in patients of any age, an abdominal syndrome is observed, which is accompanied by dyspeptic disorders (nausea, vomiting, loose stools with blood streaks). If the kidneys are involved in the pathological process, the presence of protein is detected in the urine tests of patients, hematuria is possible. With a delay in treatment, kidney damage leads to the development of chronic diffuse glomerulonephritis, followed by the formation of chronic renal failure.
Complications of the disease
It is not worth delaying the treatment of hemorrhagic vasculitis. Possible complications of this disease include the development of:
- intestinal obstruction;
- pancreatitis;
- perforation of gastric and intestinal ulcers;
- peritonitis;
- moderate anemia;
- DIC with thrombocytopenia;
- thrombosis;
- subtotal or total heart attacks;
- neuritis;
- cerebral disorders.
Similar effects of hemorrhagic vasculitisare possible only in case of ignoring the symptoms of the disease and belatedly seeking medical help. That is why it is important to start therapy as soon as possible. After all, it's not a secret for anyone that any disease is much easier to overcome in its initial stages. It is impossible to self-medicate and resort to uncontrolled intake of medicines or traditional medicine. Medicines should be prescribed only by a qualified specialist after a comprehensive examination and diagnosis.
Diagnostic procedures
Hemorrhagic vasculitis is treated by a rheumatologist. In case of a complicated course of the disease and damage to internal organs, a consultation of highly specialized specialists will also be required - a dermatologist, gastroenterologist, neurologist, nephrologist, cardiologist and pulmonologist.
Suspecting a patient with hemorrhagic vasculitis, the doctor must conduct an examination, collect an anamnesis, prescribe laboratory and instrumental studies. Expert opinions will help to get an objective picture of the disease and start appropriate therapy.
The main diagnostic methods for hemorrhagic vasculitis today are:
- coagulogram;
- analysis for the presence of immunoglobulins of classes A and G (the first indicator in vasculitis is increased, and the second is reduced), cryoglobulins and other antibodies;
- assay to detect circulating immune complexes;
- biochemical blood test;
- general (detailed) blood test (forindicators of the leukocyte formula are taken as the basis).
After making an accurate diagnosis, they proceed to the construction of a treatment regimen.
Features of treatment
Hemorrhagic vasculitis, occurring in a mild skin-articular form, requires outpatient drug therapy with strict adherence to bed rest and a diet that completely excludes the consumption of animal protein and obligate allergens. Capillarotoxicosis in the acute period requires hospitalization and constant medical supervision, and when internal organs are involved in the pathological process, the use of potent drugs prescribed in certain dosages. The group of medicines that are used to treat the disease in question (hemorrhagic vasculitis) includes the following medicines:
- Disaggregants ("Kurantil", "Trental"). They are administered intravenously by drip. Additionally, for subcutaneous or parenteral injections, "Heparin" is prescribed, which is gradually canceled with a decrease in dosage.
- Fibrinolysis activators (drugs containing nicotinic acid).
- Steroids (possible plasmapheresis).
- Cytostatics ("Azathioprine" or "Cyclophosphamide").
The duration of treatment for this disease in children and adults largely depends on its severity and clinical form. As a rule, full therapy requires 2-3 months for a mild course, up to six months for a moderate course, and about 12 months for a severe one, accompanied by relapses and nephritis.
According to ICD-10 codes, hemorrhagic vasculitis is in the same group as allergic and rheumatic purpura. The treatment of these diseases is also complicated by the lack of effective drugs that directly suppress the pathological process, regardless of its location.
Vasculitis nutrition
To prevent additional skin sensitization, diet is of the utmost importance. With hemorrhagic vasculitis, extractive substances and all products that are difficult to tolerate by the body will have to be completely excluded from the diet. Potential allergens (chocolate, coffee, honey, nuts, citrus fruits, strawberries, eggs, canned food) are also banned.
In case of abdominal and renal syndromes, the diet is selected by the attending physician, taking into account individual clinical recommendations. With hemorrhagic vasculitis complicated by nephritis, it is recommended to follow diet No. 7 (its peculiarity lies in the inadmissibility of the use of s alt and animal products).
What are the chances of recovery
It should be noted right away that with hemorrhagic vasculitis, the prognosis is very favorable. A lethal outcome in patients with such a diagnosis can occur in the acute phase of the disease due to complications from the digestive system (internal bleeding, intussusception, bowel infarction). In isolated cases, death results from renal failure or serious damage to the central nervous system.
