Vasculitis is a term used for inflammation and necrosis in blood vessel wall. There are many categories of vasculitis described in medical literature and hypersensitivity vasculitis is one among them. It is benign self limiting vasculitis (BSV) mainly related to vasculitic skin rash caused due to drug sensitivity. The common drugs associated with hypersensitivity vasculitis include penicillin, cephalosporin, sulphonamide etc. It may also be associated with several other conditions such as bacterial infection, hepatitis B and C, lupus, inflammatory bowel disease etc.
In most cases the skin is only affected. Hypersensitivity vasculitis usually affects adults particularly males.The onset of symptoms is abrupt and commonest manifestation is palpable purpura. Treatment depends on the underlying cause. For example if drug is the cause, cessation of the drug must resolve the symptoms. Infection is treated with medications.
Causes Of Hypersensitivity Vasculitis
At least in half of the patients, no cause is known for hypersensitivity vasculitis. In the rest hypersensitivity vasculitis is known to occur due to drug reaction or infection. The most common drugs that are implicated in development of this condition are antibiotics such as penicillin, cephalosporin, sulphonamide, phenytoin (used as an anti-epileptic drug), allopurinol (for gout), thiazide etc.Another prominent cause is chronic bacterial and viral infection. Infections such as hepatitis B and C, HIV infection can trigger this condition.
The rashes and other symptoms are also seen in other conditions such as systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, inflammatory bowel disease. Other probable triggers are polyarteritis nodosa, Churg-Strauss syndrome. At least 1 percent of cases account for malignancy, they include granulomatosis with polyangitis, hairy cell leukemia. Hypersensitivity vasculitis is disease of adults. It usually does not affect children.
Symptoms Of Hypersensitivity Vasculitis
The most common symptom of hypersensitivity vasculitis is skin rash. The onset of symptoms is usually sudden or it may take few days after exposure to drug or infection. There are several types of rashes recognized in hypersensitivity vasculitis. The rash can develop as small or large purple spots on skin surface which can be raised or may be flat. In some cases the rash may be burning and painful.
Some patients also complain of pain in joints. If bowel is involved, patient may experience pain in abdomen and diarrhea. Usually except for skin, involvement of other organs is less. However, if kidney is affected, patient may pass blood and protein in urine. Enlarged lymph nodes and mild to moderate fever are common symptoms in hypersensitivity vasculitis.
Diagnosis And Treatment Of Hypersensitivity Vasculitis
According to American college of rheumatology, hypersensitivity vasculitis is diagnosed if any of the 3 from 5 criteria is present.
- The patient’s age must be more than 16 years.
- Rash on skin with palpable purpura (purple spot).
- Rash may be flat or raised.
- Patient must have taken some drug before development of the symptoms.
- Skin biopsy shows presence of neutrophils (type of white blood cells) around the blood vessel.
Hypersensitivity vasculitis as mentioned before is self limiting benign pathology. It is not curable condition but with proper treatment measures the symptoms can be relieved. Following steps will help to reduce the symptoms.
- If the patient has developed skin lesions and other symptoms within few days of taking any drug, this drug must be stopped. Once patient stops taking this drug, the symptoms disappear within few days.
- If the underlying cause is infection, patient must take medication to treat the infection.
- In case of chronic infection, patient may suffer from hypersensitivity vasculitis symptoms for long period of time. In such situation, corticosteroids or anti-inflammatory medicines will be useful to alleviate pain and skin rash.
- Patients with kidney or bowel involvement may need steroids or immunosuppressant medicines for resolution of symptoms of hypersensitivity vasculitis.