Hemorrhagic Vasculitis: Symptoms And Treatment In Children And Adults

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Hemorrhagic vasculitis

Vasculitis is a whole group of diseases that are accompanied by damage to the vascular wall. Vasculitis varies depending on the cause and mechanism of development.

About 40% of all patients with diagnosed vasculitis are people under the age of 20. Hemorrhagic vasculitis in children is found in the period from 5 to 14 years. Most often men suffer from the disease.

Content:

• Hemorrhagic vasculitis - what is it?
• Causes of hemorrhagic vasculitis
• Classification of hemorrhagic vasculitis
• Symptoms of hemorrhagic vasculitis
• Diagnostics
• Treatment of hemorrhagic vasculitis
• Hypoallergenic diet for vasculitis
• Forecast
• Dispensary registration
• Complications of hemorrhagic vasculitis

Hemorrhagic vasculitis - what is it?

Hemorrhagic vasculitis is an acquired disease that causes damage to the capillaries, venules, and arterioles. Inflammation has an aseptic course, but always leads to damage to the vessel wall and contributes to the rapid formation of blood clots. With hemorrhagic vasculitis, the vessels that feed the skin and parenchymal organs suffer. Inflammation leads to the appearance of elements of a rash on the dermis. Therefore, vasculitis is called rheumatoid purpura or allergic purpura.

The disease was first described 2 centuries ago by physicians Schönlein and Genoch. Therefore, hemorrhagic vasculitis is sometimes called Schönlein-Henoch disease.

Causes of hemorrhagic vasculitis

Scientists continue to argue about the causes of the development of hemorrhagic vasculitis. It is believed that the disease most often develops in people prone to allergies. Under the influence of a number of factors, immunity stimulates the body to produce immune complexes. They are found in the blood, accumulate in the vessels that feed the skin and internal organs. These complexes damage the walls of blood vessels, blood elements seep through these injuries and remain in the surrounding tissues. Therefore, the patient has a hemorrhagic rash on the skin.

Hemorrhagic vasculitis can occur for the following reasons:

• Past infections. The danger is posed by viruses of herpes, influenza, SARS, bacteria of mycoplasma, tuberculous mycobacterium, staphylococci and streptococci, parasites (Trichomonas and helminths).
• Formulation of vaccines.
• Serum injection.
• Insect bites.
• Allergy to food.
• Burn disease.
• Hypothermia of the body.

Risk factors that increase the likelihood of developing vasculitis include:

• Advanced age.
• The period of bearing a child.
• Frequent infectious diseases.
• Allergy tendency.
• Injuries received.

Classification of hemorrhagic vasculitis

Depending on the symptoms that vasculitis gives, the following types are distinguished:

• Simple form (cutaneous vasculitis).
• Articular vasculitis.
• Renal form of the disease.
• Abdominal vasculitis (digestive system disorders prevail).
• Mixed form of the disease.

The course of the disease may vary:

• Acute vasculitis. In a month, the disease goes away.
• Subacute course of vasculitis. In this case, the disease lasts 3 months.
• Prolonged vasculitis that lasts 6 months.
• Recurrent vasculitis. In this case, for several years, the patient has 3-4 episodes of inflammation.
• Vasculitis of a chronic course. The periods of remission in this form of the disease are followed by periods of calm.
• Lightning-fast course of the disease. This form of vasculitis develops in children under 5 years of age. The disease lasts for several days.

Depending on the severity of the pathology, they are distinguished:

1. Vasculitis of the first degree. The person feels normal, the body temperature does not rise, or it may rise, but only slightly. The rash is not intense, and there are no other symptoms of the disease. In the blood test, the ESR indicator is increased, but not more than up to 20 mm / hour.
2. Vasculitis of the second degree. The patient's state of health is disturbed, the rash is intense, the body temperature rises to 38 ° C. The patient complains of headache and muscle pain, severe weakness appears. A person is diagnosed with disorders of the digestive and urinary system. ESR can reach 40 mm / hour. The level of blood albumin falls, and the number of eosinophils and leukocytes increases.
3. Vasculitis of the third degree. The intoxication of the body is strongly pronounced. There are pathological symptoms from the joints, kidneys, and digestive tract organs. Often the central nervous system and the peripheral nervous system are involved in the inflammatory process. ESR increases to 40 mm / hour, leukocytes are greatly increased, platelet levels fall. The patient develops symptoms of anemia.

Symptoms of hemorrhagic vasculitis

The manifestation of vasculitis is acute, the patient's body temperature rises. Most often this happens after 14 days from the previous infection.

Skin manifestations. The rash appears in the early stages of vasculitis. It has a hemorrhagic character and looks like bubbles. They can spread throughout the body in spots or dots. Their sizes vary, they are 1-5 mm in diameter. When you press on the elements of the rash, they do not disappear. As the pathology progresses, the rash will merge.

The rashes rise above the surface of the dermis. The maximum number of spots is observed on the extensor surfaces of the limbs. The rash appears on the buttocks and in the area of large joints. Sometimes it affects the face, chest, stomach, back.

Before the rash appears on the skin, it may itch. After a few days, the rash becomes pale. After their disappearance, pigment spots remain on the dermis.

Some elements of the rash disappear, and new ones appear. This leads to the fact that the dermis becomes variegated. The rashes are symmetrical. The more severe the vasculitis, the more intense the rash will be.

Sometimes a zone of necrosis appears in the center of the nodules or spots. Then a scab forms at this place, which disappears. This leads to the fact that after the resolution of the element of the rash, the dermis is covered with scars.

Damage to the joints. Joints are affected in 70% of patients. The person complains of pain and inflammation. The knees, ankle and wrist joints are primarily affected. If a rash appears on the skin, the pain becomes worse.

The joints themselves swell and may become deformed. This leads to a limitation of their functioning. The dermis above the joints is inflamed, at first it turns red and then becomes bluish.

The deformity of the joint is reversible as the inflammation does not persist for more than 7 days.

Abdominal Syndrome. About 50% of patients suffer from abdominal syndrome. It manifests itself as multiple hemorrhages in the intestines and in the abdominal wall. The pain occurs in attacks, proceeds as intestinal colic. Patients often suffer from vomiting and diarrhea. Blood is visible in the feces and vomit. The pain is concentrated in the navel, and sometimes spreads to the entire abdomen.

The skin becomes pale, the eyes sink, the patient's tongue is dry, the facial features sharpen.

To reduce the intensity of the pain, the person lies on their side and presses their legs to the stomach. Sometimes exacerbation of the disease leads to intestinal intussusception or intestinal obstruction. Perforation of the appendix with peritonitis is less common. After 2-3 days, the abdominal syndrome goes away on its own.

Kidney damage. Vasculitis often leads to kidney damage. They form blood clots, which cause the development of glomerulonephritis. Blood appears in the urine. It is possible to identify it during the analysis. The person complains of edema.

Kidney damage does not occur immediately. The organs are affected for a year after the onset of vasculitis. Renal syndrome occurs in 40-60% of patients.

Other symptoms of vasculitis. The spinal cord and brain are not often damaged. Even less often, a person develops pneumonia and myocarditis.

Anemia. Anemia is a complication of vasculitis. The patient has a decreased hemoglobin in the blood. He complains of increased fatigue and weakness, fainting may occur. "Flies" flash before my eyes.

Pregnancy and vasculitis. Pregnancy can cause vasculitis. It is the trigger for antiphospholipid syndrome. This can be dangerous for pregnant women, as it affects the development of the fetus. It also increases the likelihood of miscarriage, early labor and placental abruption.

In order to reduce complications of pregnancy, women with vasculitis are prescribed blood thinning drugs (Aspirin and Heparin).

Vasculitis in children. In children, the disease often proceeds without the appearance of a rash. This makes it difficult to diagnose. Children complain of joint pain and abdominal pain. Pathology has an acute course, develops unexpectedly.

If a rash appears, it covers the entire body and looks like subcutaneous bruising. The disease often recurs. In childhood, the likelihood of developing Quincke's edema increases.

Diagnostics

Routine diagnosis begins with an examination of the patient and taking an anamnesis. The doctor analyzes the information received and correlates it with the clinical manifestations of the disease.

Then he directs the patient for testing:

• Changes in the general blood test: an increase in the level of leukocytes and neutrophils, a drop in the level of hemoglobin and erythrocytes. ESR is growing. The intensity of changes in the blood picture depends on the severity of the course of the disease.
• Changes in the general analysis of urine: detection of erythrocytes, protein and cylinders in it.
• Changes in the biochemical blood test: the level of fibrinogen, haptoglobulin, sialic acids, alpha and gamma globulin increases.
• When conducting a urine sample according to Zimnitsky, its density will be reduced.
• Blood may be found in the stool.
• The coagulogram remains unchanged.
• Immunological research reveals the growth of class A immunological complexes. An increase in C-reactive protein is also likely. It is important to have a blood test for hepatitis, as these viral infections can cause vasculitis.

In addition to laboratory tests, the patient is referred for instrumental diagnostics:

• Ultrasound of the kidneys, abdominal organs.
• Kidney and skin biopsy.
• FGDS, colonoscopy, bronchoscopy.

Auxiliary survey methods are:

• Pinch test. When pressing on the skin, the patient bruises.
• Test using a tourniquet. Subcutaneous bruising is formed when a tourniquet is applied to the shoulder.
• Cuff test. After applying the tonometer cuff, the patient develops subcutaneous hemorrhages.

Treatment of hemorrhagic vasculitis

Treatment of vasculitis is within the purview of a rheumatologist. If the patient develops lesions of other organs, then he is shown consultation of narrow specialists. When the disease recurs, the patient is admitted to a hospital. At the time of exacerbation of vasculitis, a person must comply with bed rest. This prevents the development of complications.

Among medicines, it is used:

• Enterosorbents. They allow you to quickly remove harmful substances from the body. For this purpose, activated carbon, Enterosgel, etc. are used.
• Drugs aimed at preventing the formation of blood clots by improving blood circulation in small vessels: Aspirin, Curantil, Trental, Ticlopidin.
• Drugs that thin the blood, prevent the formation of blood clots, prevent it from clotting: Heparin, Fraxiparin.
• Antihistamines that relieve allergic manifestations: Tavegil, Ketotifen, Claritin.
• Solutions for intravenous infusion. They allow you to quickly remove harmful substances from the body.
• Glucocorticosteroids. They quickly stop inflammation, but they do it by suppressing the immune system. Prednisolone and Methylprednisolone are used for kidney and joint damage.
• Antibacterial drugs are prescribed for infectious complications.

Alternative treatments:

• Preparations from the NSAID group. They allow you to lower body temperature, reduce the intensity of pain and inflammation. Diclofenac, Indomethacin, Ibuprofen are prescribed for joint damage.
• Vitamins A, E, group B make the vascular wall stronger, thereby reducing the likelihood of bleeding.
• Cytostatics inhibit the activity of the immune system. These drugs are prescribed for severe illness.
• Blood transfusion and blood purification can help relieve the symptoms of vasculitis.
• Calcium preparations make it possible to compensate for the deficiency of this trace element in the body.

Symptomatic therapy. To relieve muscle spasm, drugs such as Papaverine and No-shpa allow. To minimize damage to the gastric and intestinal wall, the patient is prescribed antacids (Almagel, Maalox). They lower the acidity of gastric juice.

Severe complications, such as peritonitis or bowel perforation, require surgery.

Hypoallergenic diet for vasculitis

All patients with vasculitis need to follow a diet. Products that are capable of provoking an allergic reaction are removed from the menu. The ban includes eggs, coffee, chocolate, citrus fruits, nuts, fish and seafood.

Fatty and fried foods are not consumed in the acute period of the disease. The menu is based on low-fat products. You can eat green apples, cereals, rabbit meat, turkey.

Forecast

If the disease has a mild course, then the prognosis is favorable. In other cases, it gets worse. There is a possibility of developing serious complications: kidney inflammation, renal failure. The fulminant form of the disease can cause rapid death of a person.

Dispensary registration

Adults with vasculitis are not registered in the dispensary. The rheumatologist has been observing children for 2 years. In the first 6 months, the doctor should be visited 1 time in 30 days, the next 6 months - 1 time per quarter. Then the doctor is consulted once every six months.

A child who has suffered from vasculitis is limited in physical activity, physiotherapy and prolonged time in the sun are prohibited for him.

Complications of hemorrhagic vasculitis

Vasculitis is associated with the risk of intestinal obstruction, peritonitis, and renal failure. Sometimes the heart, liver suffers, bleeding in the lungs may occur. In children, hemorrhagic diathesis is observed.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".