Curs St. Vasculite, Paniculite

  • Published on
    25-Nov-2015

  • View
    108

  • Download
    8

Embed Size (px)

DESCRIPTION

vasculite si paniculite

Transcript

PANICULITE

PANICULITEInflamaia esutului gras subcutanatnoduliCauze:TraumatismeInfeciiBoli conjunctiv-vasculareVasculite

CLASIFICAREA PANICULITELOR

Paniculite predominant septale

Eritem nodosEritem nodos migratorP. sclerodermicP. cu deficit de 1-antitripsin

Clasificare II - Paniculite lobulare sau mixte

Eritem indurat (TBC)P pancreaticP poststeroidicLipodermatoscleroza (Insuficienta cronica venoasaP asociate bolilor de tesut conjunctiv (DM, lupic)

P lipodistroficeP traumaticeP induse infectiosP in malignitatiP cu necroz grsoas a NN

Paniculita lupica

ERITEMUL NODOS

DefiniiePaniculit septaldecada 3-4; f/b: 3:1Etiopatogenie: InfeciiMedicamenteSarcoidoz (S Lfgren)Boal Behet Boal inflamatorie cronic intestinalLimfoame, tumori malignecontraceptive, sarcin

Cauze infectioase de eritem nodosSteptococMycoplasmaYersiniaSalmonellaMycobacteriaToxoplasmaV hepatitic BBorreliaMicoze profundeCauze medicamentoase de eritem nodosPenicilineSulfonamideAnalgezice (paracetamol, ac. Acetilsalicilic, pyrazolone)Contraceptive oraleSruri halogenateERITEMUL NODOS

DefiniiePaniculit septaldecada 3-4; f/b: 3:1Etiopatogenie: InfeciiMedicamenteSarcoidoz (S Lfgren)Boal Behet Boal inflamatorie cronic intestinalLimfoame, tumori malignecontraceptive, sarcin

Eritem nodos.

Clinic: debut infeciosaspectevoluieartralgii, febrDiagnostic diferenial: hipodermite nodulare subacute, erizipel, tromboflebiteTratament: AINS

.

Tratament: Antiinflamatorii nesteroidiene: ibuprofen, diclofenac, keroprofencorticosteroizi, iodur de K

Diagnostic diferential

Paniculit cu deficit de 1 antitripsina

Paniculit pancreatic

Paniculit lupic

Eritem indurat (vasculit nodular) etiologie Tbc

VASCULITEAfectiune inflamatorie a vaselor sanguineAlterarea sau distrucia peretelui vascularPatogenezFormarea de complexe imune si depunerea lorAutoanticorpi: ANCA, atc anti-celule endotelialeAlterarea funciei celulei endotelialeGranuloame

Structura pielii

VASCULITEVasculite ale vaselor mici:- prin complexe imune:vasculite leucocitoclazicePurpura Schonlein-Henochvasculita urticarian- ANCA-pozitive: Poliangeita microscopicGranulomatoza WegenerGranulomatoza Churg-StraussVasculite de vase medii:Poliarterita nodoasVasculite ale vaselor mari: arterita cu celule giganteAlte vasculite: Boli de colagenasociate cu tumoricrioglobulinemice

Vasculite de vase mici

Aspect histopatologic de vasculit de vase mici

Purpur Schonlein-Henoch

ArtralgiiDureri abdominaleAfectare renalpurpurVasculita leucocitoclazic / vasculit alergic/tri sau tetra sindrom Gougerot:

PurpurPapuleNecrozUlceraie

Vasculit leucocitoclazicEtiologie: infecii, medicamenteReacie III Gell i Coombsclinic: purpur, papule, necrozInvestigaii: teste cutanate, teste de inflamaie, ex bacteriologicTratament: corticoterapie, AINS

Reacie de HS tip III

Vasculit necrotic

.

Vasculit leucocitoclazicEtiologie: infecii, medicamenteReacie III Gell i Coombsclinic: purpur, papule, necrozInvestigaii: teste cutanate, teste de inflamaie, ex bacteriologicTratament: corticoterapie, AINS

Urticaria vasculitis-

consum de complement: C3, C4 scazuteNormocomplementemicLeziuni persistenteEx histopatologic: endotelita, infiltrat limfocitar Vasculita urticariana

Clasificarea ACR a vasculitelor

Semne de suspiciune in vasculite sistemiceExaminareModificriSemne vitaleFebr, scdere n greutate, HTCutanatePurpura palpabil, urticarie, livedo reticular, tromboflebit superf., ulceraiiNeurologiceNervi cutanai palpabiliCap i gtSinuzit, condrit, otit, iritRenaleSensibilitate loje renaleHepaticeHepatosplenomegaliePulmonareRaluri Teste de laborator in vasculiteSistem TehnicHematologicHemo-leucogramRenalEx urin, uree, creatininHepaticTeste hepatice alterate, atc HBs, HVC, crioglobulineImunologicC, FR, AAN. Atc anti-ADN, ENA, ANCAF. InfectiosHemocultur Cap i gtRx sinus si CTPulmonarRx torace si CTCardiovascularECG, CPK, ecoCDNeurologicTeste de conducere nervoasMusculoscheletal electromiografieSistem TehnicHematologicHemo-leucogramRenalEx urin, uree, creatininHepaticTeste hepatice alterate, atc HBs, HVC, crioglobulineImunologicC, FR, AAN. Atc anti-ADN, ENA, ANCAInfectiosCulturi sngeCap i gtRx sinus si CTPulmonarRx torace si CTCardiovascularECG, CPK, ecoCDNeurologicTeste de conducere nervoasMusculoscheletal electromiografie

40TratamentCorticosteroiziDapsonAzatioprina ciclofosfamidmetotrexatERITEMUL POLIMORF

DefiniieEtiologie:- infecii (bacteriene, herpes, hepatit), - medicamente, - limfoame, carcinoame,- colagenoze

Cauze medicamentoase de eritem polimorfAlopurinolCarbamazepinCotrimoxazolLamotrigineNevirapine Antiinflamatorii nesteroidiene (tip oxicam)FenobarbitalFenitoinSulfonamideAminopeniciline, cefalosporine, macrolide, NSAID, quinolone, tramadol, tetraciclineForme clinice- EP minor: Forma papuloas: leziuni n int Forma veziculo- buloas Leziuni mucoase: 25- 60%- EP major / S. Stevens-Johnson: mucoasa bucal, mucoasa ocular, mucoasa genital, manifestari respiratorii

Eritem polimorf

.

.

Eritem polimorf form major.

.

EP major

.

.

Evoluie: acut, subacut

Diagnostic diferenial: eczem, dermatoze buloase

TratamentTratament topic: DermocorticoiziTratament sistemic:Antiinflamatorii nesteroidieneCorticosteroiziAntibioterapie (infectie bacterian)Intreruperea medicatiei posibil etiologice