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vasculite si paniculite
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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