The role of infectious agents in the pathogenesis of vasculitis

Abstract

Numerous human studies and animal models have implicated various infectious agents in the pathogenesis of vasculitis in susceptible hosts. However, the link between infection and vasculitis is very complex and only incompletely understood. In fact, different agents can induce the same type of vasculitis, as the case of leukocytoclastic vasculitis exemplifies. Conversely, the same agent can give rise to a panoply of host responses ranging from a clinically silent infection or localized organ involvement to devastating, widespread vasculitis.

Polyarteritis Nodosa

“…Subacute bacterial endocarditis (including mycotic aneurysms with distal embolization), as well as HBV, HCV, and HIV, are among the infectious diseases that can mimic vasculitis or cause vascular inflammation. 3,20,[35][36][37] Atherosclerosis, embolic disease from atrial myxomas or cholesterol deposits, segmental arteriolysis medial, calciphylaxis lesions, thrombotic disorders (antiphospholipid syndrome), fibromuscular dysplasia, and ergot use can mimic vasculitis of medium-sized arteries. 41,42 If disease affects the central nervous system, Moyamoya disease, MELAS (mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes), CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy), and granulomatous angiitis of the central nervous system are considerations.…”

“…Mild PAN cases associated with HCV and HIV should be treated with antiviral therapy. [35][36][37] Treatment of moderate to severe HCV-PAN has been adapted from the approach followed in HCV-associated cryoglobulinemic vasculitis, consisting of antiviral therapy (pegylated interferon a and ribavirin) along with immunosuppressive therapy (corticosteroids, CYC, or rituximab). 37 HIV-associated PAN seems to have an excellent response to treatment, using mostly moderate dose steroids (about 0.5 mg/kg/d) with concomitant highly active antiretroviral therapy, with rare use of cytotoxics.…”

A Clinicopathological Study of Cutaneous Small Vessel Vasculitis in a Tertiary Care Centre From North Kerala

“…4 RBC extravasation was seen in 90.5% of our cases as compared to 100% in other studies. 8,9 Most of the patients with LCV and HSP showed SVV with both neutrophilic and oeosinophilic infiltrate. Seven patients showed predominantly lymphocytic vasculitis, which could be explained by advanced age of lesion biopsied.…”

“…In the study conducted by Sais et al, out of 160 patients, 21% were p-ANCA positive and none had c-ANCA. 8,9 The direct immunofluorescence study was done only in 21 cases, clinically suspected cases of Henoch-Schonlein purpura. Analysis showed IgA positivity in 6 cases and were IgG negative.…”

“…In concordance with other reports, no specific patterns of DIF results were found in vasculitis with the different aetiologies and types. 9 In conclusion, the two most common forms of cutaneous vasculitis were LCV and lymphocytic vasculitis histopathologically and clinically, it was HSP. 10 Possible aetiological association was seen in 62.8% of cases.…”