Hemorrhagic vasculitis in adults symptoms diagnosis and treatment

The causes of vasculitis have not been studied in detail, but there is an assumption that provokes the pathology of small vessels:

  • viral and bacterial infections (influenza, acute respiratory viral infections, tonsillitis, sinusitis, measles, tonsillitis, chickenpox, typhus, streptococcal disease);
  • mechanical damage to the skin and blood vessels;
  • excessive influence of solar radiation;
  • allergic reactions to medicines;
  • vaccinations and routine vaccinations;
  • food allergies;
  • poisoning;
  • helminthic invasions;
  • hypothermia;
  • allergies to insect bites;
  • malignant and benign neoplasms;
  • pregnancy;
  • endocrine diseases;
  • genetic predisposition in the family.

The causes of hemorrhagic vasculitis are a decrease in the elasticity of blood vessels, as a result of which gaps, blood clots and bruising are formed. The disease can develop on the basis of age-related changes and with reduced immunity. This is understandable, because an organism with weakened defenses is more susceptible to various infections and inflammatory diseases.

Why is there an ailment that is also called Shenlein-Genoch disease and capillarotoxicosis? The mechanism of development of vasculitis is quite simple: an aseptic inflammatory process occurs in the capillaries caused by the damaging effect of the immune complexes of antibodies. Shenlein-Genoch disease is manifested by hemorrhages, a malfunction in the processes of intravascular coagulation and a violation of blood circulation in small arteries.

The causes of hemorrhagic vasculitis in patients of any age are conditionally divided into several categories:

  • complications after an illness (respiratory viral infection, chickenpox, herpes, scarlet fever) caused by pathogenic microflora and parasites;
  • allergic reactions;
  • hypothermia;
  • vaccine intolerance;
  • hereditary predisposition.

The main factor in the occurrence of hemorrhagic vasculitis is the formation of immune complexes consisting of antibodies. These formations are deposited on the inner surface of the arterial walls, which cause microscopic damage to blood vessels and, as a result, provide conditions for the development of post-traumatic aseptic inflammation.

Accordingly, with inflammation of the vascular tissue, its elasticity decreases markedly, as a result of which the walls become permeable, gaps appear. This state of arteries and capillaries leads to fibrin deposits and the formation of blood clots. The above explains the appearance of symptoms of vasculitis – bruising provoked by microtrombosis of blood vessels.

The causes of the disease today are still controversial. It is believed that the development of this process requires a certain state of the body’s defense system, that is, a person should be prone to allergic reactions. After the action of certain factors, the immune system provokes the formation of certain immune complexes that circulate in the bloodstream and are deposited in the skin vessels and internal organs.

The main causes of the disease include:

  • infectious agents are primarily viruses (herpes, influenza, respiratory infection), bacteria (mycoplasmas and streptococci, the causative agent of tuberculosis and staphylococci), parasitic infection (helminths, trichomonads);
  • vaccination and administration of sera;
  • taking certain medications (barbiturates, streptomycin, penicillin and others);
  • insect bites;
  • burn disease;
  • food allergy;
  • hypothermia

The risk factors for the development of the disease include:

  • elderly age;
  • pregnancy;
  • frequent infections;
  • tendency to atopic reactions;
  • injuries.

The causes of the disease are not exactly established. It is considered to be autoimmune. However, a connection with the activation factors of pathological processes was revealed. These include:

  • transferred viral and bacterial infectious diseases, of particular importance is acute and chronic inflammation in the upper respiratory tract (influenza, SARS, tonsillitis, sinusitis), measles, frequent tonsillitis, chickenpox, typhus, typhus, streptococcal diseases;
  • traumatic injuries of the skin and blood vessels;
  • the effect of increased doses of solar radiation (with prolonged tanning), temperature fluctuations, radiation;
  • allergic reactions to drugs (often antibiotics, sedatives and antihypertensives);
  • vaccinations during routine vaccination; prophylactic use of immunoglobulins;
  • food allergies;
  • domestic and occupational poisoning, toxicoinfection;
  • in children – helminthic infestations;
  • reaction to an insect bite;
  • body restructuring in malignant and benign tumors;
  • changes in women during pregnancy;
  • metabolic disorders in endocrine diseases (diabetes mellitus);
  • genetic predisposition in the family.

Hemorrhagic vasculitis in adults develops more often in old age, with weak and impaired immunity.

Renal thrombosis leads to multiple heart attacks, hemorrhages, loss of organ function

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Varieties

Today, doctors know several forms of hemorrhagic vasculitis. Depending on the clinical picture, the ailment happens:

  • skin;
  • articular;
  • abdominal, that is, developing in the abdominal cavity;
  • renal;
  • combined.

The disease can occur simultaneously in several forms. Among the most common combinations, cutaneous-articular vasculitis is most common. Specialists also call this form simple. Depending on the severity of the pathology, she is assigned the degree of small, medium and high activity. Another typology of hemorrhagic vasculitis is built according to the nature of the course of the disease. So, capillarotoxicosis can be:

  • lightning fast (develop literally in a matter of days);
  • acute (the duration of the disease usually does not exceed 30-40 days);
  • protracted (leaking over 2 months);
  • recurrent (symptoms of the disease are repeated several times over 3-4 years);
  • chronic (the clinical picture remains unchanged for 1,5-2 years, remissions alternate with frequent or rare exacerbations).

The mechanism of vascular damage

The severity of the course is characterized by hemorrhagic vasculitis in adults, which is accompanied by damage to the vessels of the gastrointestinal tract. Often the appearance of abdominal pain is ahead of the hemorrhagic rash. Unpleasant sensations arise when small capillaries rupture on the walls of the intestine, and therefore are acute cramping. Patients, describing the discomfort, note that it mainly occurs in the umbilical, right iliac and hypochondrium.

The pain syndrome with hemorrhagic vasculitis resembles the clinical picture caused by appendicitis, ulcer perforation or intestinal obstruction. The pain can last for 3-10 days. Often the disease occurs with nausea and vomiting, in which mucus and bloody impurities are present. By the way, blood in the feces with an abdominal form of vasculitis is a very common symptom. In severe cases, intestinal bleeding develops, resulting in a sharp drop in blood pressure and collapse.

The main factor in the defeat of hemorrhagic vasculitis are special complexes formed from immune cells. They are called anaphylotoxins for destructive abilities. Under normal conditions, they break up. In a sick person, complexes accumulate and become antigens.

Deposition on the inner wall of blood vessels with a change in permeability causes a violation of blood circulation:

  • platelets are activated;
  • the plasma content of specific antithrombin decreases;
  • the fibrinolysis process is blocked.

As a result, a mass of microthrombi forms in small vessels against the background of allergic inflammation and reduced blood coagulation.

Causes and mechanism of development

Speaking about the clinical manifestations of the described vascular pathology, it is worth noting that the same symptoms of hemorrhagic vasculitis are observed in adults and children. At the same time, the features of the course of the disease may vary depending on age. Mostly the disease is manifested by spotted rashes on the epidermis. They are called skin hemorrhagic rash.

In the articular form of vasculitis, patients complain of pain in the ankle joints. This symptom occurs in seven out of ten cases. With the abdominal form of hemorrhagic disease, its inevitable manifestation is a dull, aching pain in the abdomen.

In complicated hemorrhagic vasculitis, the vessels of internal organs, including the kidneys, lungs, and brain, are often affected in adults. The most favorable prognosis is given to patients in whom the disease proceeds only with superficial manifestations in the form of a hemorrhagic rash.

Consider the stages and first symptoms of hemorrhagic vasculitis. With the skin type, first of all, starting from the shin to the foot of the foot, rashes of a reddish hue appear, then they can be activated up to the gluteal region, when pressed, the spots do not disappear, in contrast to the usual allergic reaction.

With a mild course of the disease, the temperature does not rise, rashes cover small areas of the skin. The disease can express itself more aggressively, at first there will be malaise, a headache, an upset stomach and a fever of up to 38 ° C, and a large area of ​​the body will be covered with a rash.

Like any disease, hemorrhoidal vasculitis has a number of symptoms by which a doctor can diagnose a pathological condition. Among the signs of pathology, several syndromes are noted that contain visible manifestations of the disease:

  1. Skin syndrome develops in the form of small hemorrhages, slightly rising above the skin. The diameter of the rash varies – 3-10mm. The location of hemorrhages can be different – near the joints, especially the lower extremities, on the hands and feet, hips, buttocks, on the trunk. If the rash develops in the upper body, then this is not typical. Rashes do not cause significant inconvenience of a physiological nature, although in rare cases they may be accompanied by itching. After the bruising subsides, pigmentation can develop in its place – a significant darkening of certain areas of the skin. Despite the large number of visible symptoms, hemorrhagic vasculitis in adults does not cause oral hemorrhage or nosebleeds, as most patients mistakenly believe.
  2. Joint syndrome manifests itself in the form of characteristic painful sensations in the joints, mainly they affect the lower extremities. Often there is a swelling and discoloration of the surrounding skin to red and blue. Joint syndrome is short-term in nature and, as a rule, does not last more than a week, no visible deformations of the joint itself due to vasculitis are noted.
  3. 3. Abdominal syndrome manifests itself in the form of painful sensations of insignificant intensity in the abdomen. In rare cases, the pain can be paroxysmal. The location can be different, but most often it occurs around the navel. Due to constant attacks, the patient can change externally – his skin acquires a pale shade, his eyes sink, his facial features are sharpened. Often with hemorrhagic vasculitis, symptoms appear in the form of vomiting and loose stool with bloody particles. The causes of such problems lie in numerous hemorrhages in the intestine and in the abdominal cavity. Pain in the abdomen disappears after about 3 days after the patient begins to treat hemorrhagic vasculitis.
  4. Renal syndrome develops when small loans in the kidney become inflamed. This can occur in the admixture of blood in the urine and feces, swelling of the face, sharp increases in blood pressure.
  5. Anemic syndrome consists in the general weakness of the body, a decrease in hemoglobin level, dizziness, fainting, noise in the ears, shortness of breath and flickering flies before the eyes.
  6. Other syndromes may develop if the causes of vasculitis lie in damage to the brain, heart muscle, or lungs.

In children and in older patients, there are certain differences in the development of the disease. In an adult, the disease begins at a more relaxed pace, without pronounced symptoms, nausea and vomiting, which is typical for a childhood form of the disease. If small vessels in the kidneys are affected, then in 53% of cases, renal failure will manifest itself on the basis of vasculitis.

Since vasculitis can occur in different ways, the consequences of the disease will differ among themselves. If a person does not begin to timely eliminate the above symptoms, complications will appear:

  • intestinal obstruction;
  • perforation of stomach and intestinal ulcers;
  • pancreatitis;
  • thrombosis and heart attacks in internal organs;
  • peritonitis;
  • posthemorrhagic anemia;
  • pulmonary hemorrhage;
  • DIC syndrome with thrombocytopenia;
  • cerebral disorders;
  • neuritis.

To avoid prolonged treatment and possible consequences, it is much more reasonable to seek help from a qualified doctor at the first alarming “calls” of the body. Any pathology is easier to prevent than to cure, this moment once again confirms the advisability of an annual visit to a doctor for preventive purposes.

Stains on the skin with vasculitis

As already noted, with any form of this disease, bruising is observed on the skin. The defeat of the epidermis is the main manifestation of hemorrhagic vasculitis. It occurs in absolutely all patients, regardless of the manifestation of additional symptoms. Skin rashes can occur both at the very beginning, in the first stages of the disease, and after some time, as the pathology progresses.

The most characteristic is the appearance of purpura – small-spotted hemorrhages, palpable palpation. Such a rash is symmetrical, consists of small (1 to 3 mm) nodules. First, rashes affect the feet and lower legs, but later spread throughout the limb. In addition to purpura, other elements (vesicles, redness with peeling, and in severe cases even necrotic areas of the upper layer of the epidermis) may appear.

Clinical classification

Depending on the clinical picture, the following forms of the disease are distinguished:

  • skin or simple form;
  • cutaneous articular form;
  • renal form;
  • abdominal (manifestations from the abdomen);
  • combined or mixed form.

Depending on the course of the disease, there are:

  • acute (the process wanes over the course of a month);
  • subacute (the disease lasts up to 3 months);
  • protracted course (the disease lasts up to six months);
  • recurrent course (for several consecutive years, the symptoms of hemorrhagic vasculitis return 3-4 times or more);
  • chronic course (the clinical picture persists for up to one and a half years or more with periodic exacerbations of the process);
  • fulminant course (usually found in children under 5 years old and lasts several days).
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Clinicians distinguish the following forms of the disease:

  • simple or skin – the whole process is limited to skin manifestations;
  • cutaneous-articular – in addition to characteristic skin rashes, there are signs of joint inflammation;
  • cutaneous abdominal – against the background of skin changes, symptoms of impaired function of the stomach and intestines are manifested;
  • renal – is rare, is accompanied by damage to the renal vessels with impaired filtration and excretion of urine;
  • mixed (combined) – there is a changing symptomatology of different forms.

According to the type of disease, there are:

  • fulminant form – characterized by a rapid course, lasts several days, occurs in children under 5 years old;
  • acute – the disease has a sudden onset and lasts up to 30 days;
  • subacute – lasts up to three months;
  • protracted – clinical manifestations last for six months;
  • recurrent – characterized by a recurrence of symptoms at least four times in the next few years;
  • chronic – the clinical picture of the disease lasts several years with periodic exacerbations.

There are 3 degrees of qualification: depending on the clinical picture, on the course and degree of the disease.

Vasculitis is subdivided on the basis of the clinical course into cutaneous, renal, articular, abdominal or mixed types:

  • The most common option is the skin type.
  • The joint type covers both the skin of a person and his joints, they become swollen and very painful.
  • The renal type is manifested by the inflammatory process of the kidneys, passing into nephrotic syndrome.
  • The abdominal type includes bowel damage.

The course of the disease is: fast (within 2-3 days), acute (up to a month), prolonged (up to 3 months), chronic (ongoing on an ongoing basis).

The degree of hemorrhagic vasculitis disease is observed to be small, medium and high.

Modern science has already studied this disease quite well, there is even a certain classification of inflammatory processes in the blood vessels. Hemorrhagic vasculitis can differ in the nature of its course:

  • fulminant – develops within a few days;
  • acute – the duration is at least 30-40 days;
  • protracted – develops over 2 months or more;
  • recurrent – re-infection occurs 3-4 times a year;
  • chronic vasculitis – the symptoms of the disease persist for more than 2 years, while its exacerbation can be cyclical.

The rate of development of the disease directly depends on the content of various proteins in the blood plasma, the level of circulating immune complexes, etc.

Pain in the joints

Seventy percent of case histories show the severity of vasculitis symptoms such as joint pain. This symptom often appears along with rashes in the first weeks of the disease. Changes in the articular surfaces and internal departments may be accompanied by minor and short painful sensations, but a wider lesion is not excluded, in which not only large (ankle and knee) joints are affected, but also joints of the toes.

General and skin symptoms

Symptoms of hemorrhagic vasculitis usually appear suddenly without a prodromal stage. The growth of the clinic occurs in a few weeks. In most cases (especially in adults), fever rises or subfebrile condition is maintained. Patients feel unwell, weak, headache. These are the initial signs of intoxication. The diagnosis is still unclear, since so many diseases.

A more typical symptom is a varied rash on the body. It can appear on the back of the feet, buttocks, legs. Less often on the stomach, arms, back. It is usually symmetrical.

For hemorrhagic vasculitis, skin manifestations on the face, neck, palms and sole of the feet are uncharacteristic. This symptom is taken into account in differential diagnosis.

According to the description, the elements of the rash are different:

  • bright red small blisters;
  • papules turning pale with pressure;
  • the location of red papules on the mucous membrane of the mouth and pharynx is possible;
  • purple nodules;
  • small bruises.

The diameter of the small elements of the rash reaches 1 cm. They last up to four days, then turn pale and disappear. The next wave of skin manifestations should be expected after 7-10 days.

The initial manifestations most often look like a small petechial rash, localized on the legs and upper legs.

Gradually, rashes reach the hips and buttocks.

Much less often, the hands, back and stomach are involved in the process. At the same time, patients experience severe itching in the rash zone, on the surface of the head covered with hair, around the eyes.

On examination, swelling of the lips, eyelids, and perineum is noted. The rash area is painful when touched. After the disappearance of the spots, age spots remain, during relapse they give peeling.

Among the symptoms of hemorrhagic vasculitis, it is important to highlight the damage to internal organs and joints.

The classic signs of arthritis appear:

  • soreness of movements;
  • swelling;
  • redness.

Joint syndrome can develop simultaneously with skin rashes or manifests itself gradually in 70% of patients, becoming more pronounced with each exacerbation. For adult patients, it is more characteristic, in ¼ patients it precedes skin rashes, and the pains are migratory in nature.

According to the intensity of pain, options are possible: from moderate discomfort during movements to severe inflammation, followed by a change in shape due to severe swelling. Joint deformities and persistent motor disorders do not occur. The pain lasts for several hours.

From the digestive organs are observed:

  • short-term abdominal pains cramping in nature (colic);
  • nausea and vomiting;
  • an admixture of blood in the feces due to bleeding of the intestinal mucosa.

In children, an increase and soreness of the inguinal lymph nodes is detected.

23% of sick children have abdominal syndrome. The pains are associated with swelling and rashes along the peritoneum. Usually they do not cause serious stool disorders. Manifested simultaneously with skin rashes or later, do not cause a significant deterioration in the patient’s condition, often detected with a targeted survey.

If the treatment for hemorrhagic vasculitis is late, then an adult will experience vomiting, diarrhea with blood as signs of gastric and intestinal bleeding.

Moderate, non-hazardous bleeding occurs in half of patients. Cases of massive blood loss occur in 5%. Severe complications are occasionally possible:

  • perforation of the wall with the development of peritonitis;
  • intestinal invagination.

During endoscopic examination, patients find signs of hemorrhagic or erosive gastritis, duodenitis, less often, another localization in the intestine.

Elements are able to merge and form common areas of crimson color

Anemic syndrome is caused by a decrease in the content of hemoglobin, red blood cells. It manifests itself:

  • dizziness;
  • weakness;
  • noise in the head;
  • fainting conditions;
  • flickering of “flies” before the eyes;
  • tachycardia.

Kidney damage is observed in 10-60% of patients, it causes:

  • acute glomerulonephritis of an autoimmune nature;
  • an admixture of blood in the urine (red blood cells pass through the wall of inflamed arterioles).

Usually begins 1-3 weeks after skin rashes. Isolated form is rare.

If the respiratory tract and lobules of the lungs are affected, the patient is coughing, shortness of breath. In the sputum may be an admixture of blood due to increased bleeding of the capillary bed.

On the part of the cardiovascular system, pronounced tachycardia, a tendency to arrhythmias, are noted.

Damage to the nervous system is attributed to the adverse effects of the disease. They are caused by the transition of inflammation from blood vessels to the meninges. Therefore, symptoms of meningitis, encephalitis (severe headaches, impaired coordination, convulsions) are manifested.

Hemorrhagic vasculitis in adults and children is significantly different. In adults, the onset of the disease is very difficult to determine, because the symptoms are insignificant, intestinal problems are observed in less than 50% of patients, and manifestations of impaired renal function and rashes in a small area are possible.

With the onset of the disease, children develop a high fever, loose stools with drops of blood and also kidney failure, the rash covers a significant part of the skin.

Shenlein-Genoch disease, as a rule, begins acutely, with an increase in temperature and often after a person has had an acute respiratory infection (after a couple of weeks). For hemorrhagic vasculitis, a triad of symptoms is characteristic: skin rashes, joint damage and abdominal syndrome.

Skin syndrome

Skin rashes occur in all or almost all patients and are observed at the very beginning of the process. Rashes look like papules (vesicles) of a hemorrhagic (with blood contents) character. Papules can be either in the form of dots or in the form of spots, ranging in size from 1 to 5 mm. They do not disappear with pressure, and later merge with each other.

The rash is slightly elevated above the skin surface and is usually localized on the extensor surfaces of the arms and legs. Also, rashes appear on the buttocks and around large joints involved in the pathological process. Possible spread of hemorrhagic purpura on the face, abdomen and chest, as well as the back.

In some cases, skin rashes or hives precede the appearance of skin rashes. After a few days, hemorrhagic purpura begins to turn pale and undergo a reverse, but slow development. First, the rashes turn brown, and then leave pigmented spots on the skin.

Often, against the background of old rashes, fresh ones appear, and the skin looks mottled. For rashes, symmetry is characteristic. The number of rashes, as well as the severity of other manifestations of the disease, depends on the severity of the process.

In rare cases, necrosis is possible in the center of the papule (necrotic variant), after which a crust forms, which later disappears. In this regard, scars form on the skin.

Joint syndrome

Joint damage occupies the second place among the clinical manifestations of hemorrhagic vasculitis and is found in 70% (according to some reports, in 100%) of patients. Joint syndrome is manifested by arthralgia (joint pain) and significant inflammation of the joints. Usually large joints are involved in the process (knee and ankle and less often elbow and wrist).

Joint pain is more pronounced in the event of a rash around the affected joints.

Swelling of the diseased joint and its deformation are characteristic, which leads to impaired movement in it. The skin over the affected joints first turns red, and then becomes cyanotic.

Joint syndrome lasts, as a rule, no more than a week and does not lead to persistent deformation of the joints.

Abdominal symptoms occur in half of patients and are caused by numerous hemorrhages in the peritoneum and intestinal wall. Abdominal syndrome manifests itself with sudden paroxysmal abdominal pain (intestinal colic), but moderate pain is also possible. At the peak of pain, the patient develops vomiting with blood and stool with blood (melena). Pain troubles, as a rule, around the navel, but pain in other parts of the abdomen is possible, which resembles appendicitis, cholecystitis or pancreatitis.

In parallel with pain, pallor of the skin and mucous membranes appears, a haggard face, eyes sag, tongue becomes dry, and facial features are sharpened.

Signs of peritoneal irritation (peritonial symptoms) are also determined. A pain attack makes the patient take a forced position: lying on his side with legs bent and pressed to his stomach.

Perhaps the development of surgical complications requiring surgery: intussusception or intestinal obstruction, perforation of the appendix with the occurrence of peritonitis. Abdominal syndrome usually stops on its own within two to three days.

Renal syndrome

Often with hemorrhagic vasculitis, the kidneys are also involved in the process. Renal damage is caused by the formation of blood clots in the small vessels of the renal glomeruli, which leads to the development of glomerulonephritis. Clinically, renal syndrome is manifested by micro- and macrohematuria (blood in the urine is detected), proteinuria (protein in the urine) and nephrotic syndrome, that is, edema.

Other symptoms

Other manifestations of the disease are quite rare. This may be involvement in the process of the brain and spinal cord, hemorrhagic pneumonia, myocarditis, etc., which are diagnosed with the help of special studies.

Anemic syndrome

The development of anemia in hemorrhagic vasculitis is considered a complication of the disease. Clinically, a decrease in hemoglobin is manifested by general weakness and fatigue, shortness of breath, dizziness and fainting, tinnitus and flickering “flies” in front of the eyes.

As indicated in the causes of the disease, bearing a fetus can provoke the occurrence of Shenlein-Genoch disease. Since the disease is systemic, it “triggers” antiphospholipid syndrome. Antiphospholipid syndrome during gestation is fraught with a delay in the intrauterine development of the child, miscarriage or premature birth, placental abruption. In the event of a disease during gestation at low doses, aspirin and heparin are prescribed.

How does the fulminant form proceed?

Differences in the course of the disease in children and adults are in its development. In adults, the clinical picture is blurry. For this reason, at the initial stages, the diagnosis of hemorrhagic vasculitis is difficult, because the symptoms are not fully manifested. The patient’s general well-being practically does not suffer.

In children, the pathology of small vessels has an acute onset. Vasculitis in children under 6 years of age develops rapidly, accompanied by fever, chills and weakness. Moreover, in half the clinical cases in patients of any age, an abdominal syndrome is observed, which is accompanied by dyspeptic disorders (nausea, vomiting, loose stools with streaks of blood).

To choose the right therapy for hemorrhagic vasculitis, the doctor needs to know the degree of activity of inflammatory phenomena in the vessels. According to the clinic and the simplest laboratory tests, it is customary to distinguish 3 degrees:

  • Grade I – the patient’s condition is satisfactory, the temperature is not elevated or slightly above 37, there are moderate non-common skin rashes, ESR in the blood is not higher than 20 mm / hour, there are no other manifestations.
  • Grade II – the patient’s condition is moderate, skin manifestations are intense, body temperature is over 38 degrees, there are signs of intoxication (muscle and headaches, weakness), viv >

Most often the ankle and knee joints are affected, rarely – the elbows and the wrist

The basis of the fulminant pathology is determined by a hyperergic reaction with the subsequent development of acute necrotic thrombosis and vasculitis.

Pathology often affects babies of the 1st year – 2 years old, is associated with childhood infections (chickenpox, rubella, scarlet fever). It is manifested by typical extensive areas of hemorrhages on the skin, necrosis, cyanotic large drain spots on the hands, feet, buttocks, face. Then gangrene of the hands and feet, shock, coma develops.

Learn more about the clinical manifestations of Shenlein-Genoch disease in children here.

In the presence of hemorrhagic vasculitis, the symptoms can be very different. The following clinical syndromes are possible:

With systemic vasculitis, vessels of any area are involved in the process. In almost all patients, skin signs of vasculitis are observed. These include a rash. It has the following features:

  • occurs in the early stages of the disease;
  • located symmetrically;
  • localized in the extremities, buttocks and trunk;
  • represented by red papules or blisters;
  • may lead to tissue necrosis;
  • does not disappear with pressure on the skin.

Exanthema is abundant or mild. In some children, the rash is urtical. In severe cases, ulcer defects and crusts appear in its place. With the disappearance of exanthema, hyperpigmentation of the skin is observed. The relapsing course of the disease is characterized by peeling. Itching is not observed.

Hemorrhagic vasculitis (skin form) is always manifested by fever. The temperature rises to 38 ° C and above. Symptoms such as weakness, decreased activity, muscle and head pain are possible. Hemorrhagic vasculitis in children and adults is characterized by abdominal syndrome. It is manifested by abdominal pain, impaired stool, nausea and vomiting.

The severe course of the disease leads to massive bleeding. They are manifested by a drop in pressure, pallor of the skin, heart palpitations. In most cases, systemic vasculitis occurs with moderate bleeding. If a person is not cured, then there is a risk of developing intestinal invagination, wall perforation and inflammation of the peritoneum.

Perhaps the development of melena (loose stool black). Some patients have frequent urination. The abdominal syndrome disappears after 2-3 days. In severe cases, the kidneys are affected. Nephrotic (urinary syndrome) develops. With kidney damage, signs such as hematuria, swelling of the legs and face, an increase in the protein content in urine are possible. Vasculitis leads to joint damage like polyarthritis. This is manifested by pain.

Complications of the disease

To delay with the treatment of hemorrhagic vasculitis is not worth it. The likely complications of this disease include the development of:

  • intestinal obstruction;
  • pancreatitis;
  • perforation of ulcers of the stomach and intestines;
  • peritonitis;
  • moderate anemia;
  • DIC syndrome with thrombocytopenia;
  • thrombosis;
  • subtotal or total heart attacks;
  • neuritis;
  • cerebral disorders.

Similar consequences of hemorrhagic vasculitis are possible only if you ignore the symptoms of the disease and delayed seeking medical help. That is why it is important to start therapy as soon as possible. After all, it is not a secret for anyone that it is much easier to overcome any disease in its initial stages. It is impossible to self-medicate and resort to uncontrolled taking of medicines or traditional medicine. Medications should be prescribed only by a qualified specialist after a comprehensive examination and diagnosis.

Diagnostic procedures

The treatment of hemorrhagic vasculitis is carried out by a rheumatologist. With a complicated course of the disease and damage to the internal organs, it will also require consultation of narrow-profile specialists – a dermatologist, gastroenterologist, neurologist, nephrologist, cardiologist and pulmonologist.

Suspecting hemorrhagic vasculitis in the patient, the doctor should conduct an examination, collect an anamnesis, prescribe laboratory and instrumental studies. Expert opinions will help to get an objective picture of the disease and begin appropriate therapy.

The main diagnostic methods for hemorrhagic vasculitis today are:

  • coagulogram;
  • analysis for the presence of immunoglobulins of >

After making an accurate diagnosis, they proceed to the construction of a treatment regimen.

Treatment of hemorrhagic vasculitis is a very important process, but before it begins, the doctor must accurately confirm the diagnosis. He does this through laboratory tests and using instrumental research:

  • analysis of blood, feces and urine
  • ultrasound examination of the kidneys;
  • ECG;
  • bone marrow puncture;
  • skin biopsy;
  • endoscopic examinations (fibroesophagogastroduodenoscopy, colonoscopy, bronchoscopy, laparoscopy).

The patient’s complaints and the presence of visible signs of the disease are necessarily taken into account. To determine the duration of bleeding, characteristic tests can be performed, which include piercing the earlobe or finger. The duration of the formation of a blood clot is estimated.

A pinch test also gives a certain amount of information about the state of human health. The essence of the procedure is to squeeze a small area of ​​the skin under the collarbone, if there is a slight bruising, then there is a pathological condition of the vessels, normally there should be no bruising. A similar test is carried out using a tourniquet, the forearm region is pressed down.

Before treating the pathology, the doctor may appoint an additional consultation with a rheumatologist and hematologist. Based on the information received about the patient’s health status, the attending physician begins to develop a therapy regimen, depending on the person’s age and the presence of concomitant diseases.

Features of treatment

Hemorrhagic vasculitis, proceeding in a mild skin-articular form, involves outpatient drug therapy with strict adherence to bed rest and diet, which completely eliminates the consumption of animal protein and obligate allergens. In the acute period, capillarotoxicosis requires hospitalization and constant medical supervision, and with the involvement of internal organs in the pathological process, the use of potent drugs prescribed in certain dosages. The group of drugs that are used to treat the disease in question (hemorrhagic vasculitis) includes the following medications:

  • Disaggregants (Curantil, Trental). They are administered intravenously by drip. Additionally, for subcutaneous or parenteral injections, “Heparin” is prescribed, which is gradually canceled with a lower dosage.
  • Fibrinolysis activators (drugs containing nicotinic acid).
  • Steroids (plasmapheresis is possible).
  • Cytostatics (“Azathioprine” or “Cyclophosphamide”).

The duration of treatment of this disease in children and adults largely depends on its severity and clinical form. As a rule, for the implementation of full-fledged therapy, it takes 2-3 months with a mild course, up to six months with moderate and about 12 months with severe, accompanied by relapse and nephritis.

According to the ICD-10 encodings, hemorrhagic vasculitis is in the same group as allergic and rheumatic purpura. The treatment of these diseases is also complicated by the lack of effective drugs that directly suppress the pathological process, regardless of its location.

How is the treatment carried out?

Treatment of hemorrhagic vasculitis begins with the doctor’s recommendations on the regimen and diet.

With exacerbation, strict bed rest is required. Hospitalization of the patient to the hospital is desirable, since correction and selection of medications is necessary. Often they are administered drip and intramuscularly.

Out of exacerbations, patients should not be in the sun, physical activity is limited.

A diet for hemorrhagic vasculitis should exclude products that cause allergies and increase blood clotting.

It is not recommended to use in food:

  • coffee and cocoa;
  • candies;
  • citrus fruits;
  • eggs;
  • spicy seasonings, mayonnaise;
  • red varieties of berries;
  • fried and smoked meat, fish dishes.

Chocolate is considered a strong food allergen.

With the development of abdominal syndrome, the patient is prescribed nutrition by intravenous administration of special solutions. Dietary dishes are prepared according to the principle of table No. 1 (exacerbation of peptic ulcer).

Usually hemorrhagic vasculitis treats and is observed in a clinic by a rheumatologist. Medicines of different groups are used.

For the prevention of increased coagulability, it is prescribed:

  • disaggregants (Curantil, Trental);
  • Heparin (dose is calculated on the weight of the patient);
  • as an activator of the fibrinolysis process, nicotinic acid in injections.

Corticosteroids are used to relieve inflammation, possibly a combination of tablets and intramuscular injections.

To limit the autoimmune process, cytostatics (Azathioprine, Cyclophosphamide) are rarely used. They are prescribed only in severe cases, for example, with autoimmune glomerulonephritis.

The dosage is selected individually in each case. You cannot change or cancel it yourself.

According to the indications, plasmapheresis, transfusion of blood components.

Nutrition for vasculitis

In addition to traditional drug treatment, the patient is required to follow a diet, bed rest and, if possible, undergo climatotherapy. Dietary foods include the exclusion of foods such as chocolate, eggs, citrus fruits and nuts. Your diet should be replenished with vitamin-containing products. Coffee, salt and spices are also limited, because they prevent the body from absorbing nutrients and medications.

During an illness, a person has a huge amount of calcium washed out of the bones, so it must be supplemented with dairy products, but of low fat content. During therapy, you should completely abandon smoked, fried and canned food. After a complete cure, it is advised to continue the diet for at least 2 months, this will fix the result of therapy.

Among alternative methods of treating hemorrhagic vasculitis, hirudotherapy, which a hundred years ago was the main principle of the treatment of vascular diseases, should be mentioned. In the saliva of leeches, there is a unique substance that strengthens the walls of blood vessels and improves the quality of blood. But, despite the effectiveness of the procedure, few patients decide on it, as they experience psychological discomfort in contact with these organisms.

As a prophylaxis of vasculitis, timely treatment of infectious diseases, adherence to a proper lifestyle, and the absence of abuse of medications, in particular painkillers and antibiotics, are required. The human body is a holistic mechanism and sometimes a malfunction of one organ can manifest itself in a number of atypical symptoms, without the appropriate education and medical skills, you will not be able to identify a disease such as vasculitis. That is why do not waste time and at the first alarming symptoms you go to the doctor.

Hemorrhagic vasculitis rarely leads to death, but complications of the disease can adversely affect the body. Recovery occurs with timely therapy in 80% of patients. After the traditional treatment, the person will be registered for another 2 years to exclude the development of a relapsing or chronic form of the disease. As a concomitant treatment, it is recommended to deal with the elimination of rhinitis, sinusitis, sinusitis and dental caries.

To prevent additional sensitization of the skin, diet is of utmost importance. With hemorrhagic vasculitis, extractive substances and all products that are difficult to tolerate by the body will have to be completely excluded from the diet. Potential allergens (chocolate, coffee, honey, nuts, citruses, strawberries, eggs, canned food) are also prohibited.

With abdominal and renal syndromes, the attending physician selects the diet taking into account individual clinical recommendations. With hemorrhagic vasculitis complicated by nephritis, it is recommended to follow diet No. 7 (its peculiarity is the inadmissibility of salt and animal products).

Do I need alternative medicines?

The use of folk remedies in the active phase of the disease is contraindicated. Patients are advised to follow up a rheumatologist up to two years after the last relapse. In chronic form – for life.

In the inter-relapse period, prophylactic treatment of any existing chronic foci of infection is recommended: sinusitis and other sinusitis, carious teeth, tonsillitis, giardiasis cholecystitis, helminthiases. It should be remembered that physiotherapeutic procedures are contraindicated for patients. You can use folk remedies without an allergenic effect to rinse your throat and mouth, remove helminths.

Tansy flowers are part of anthelmintic fees

Decoctions of plants are used:

  • tansy,
  • dandelion root
  • wormwood
  • ginger
  • elecampane
  • star anise
  • clove seeds.

Modern methods of therapy give a good effect for skin and joint manifestations. It is possible to prevent severe damage to internal organs. For timely diagnosis and treatment should consult a doctor.

Traditional medicine has a large arsenal of recipes for almost all occasions. She did not fail this time either, to eliminate the visible symptoms of hemorrhagic vasculitis, healers offer the following treatment methods:

  1. Tansy, dandelion roots, wormwood are poured with boiling water and insist for an hour and a half in a thermos. Then they drink 0,5 cups 4 times a day.
  2. Ginger and elecampane perfectly remove signs of poisoning. They are brewed in the form of tea, you can add a little honey to improve taste. Drink 3 times a day for 1 glass.
  3. Hemlock tea can strengthen the walls of blood vessels, reduce their permeability and improve the development of recovery processes in the body. Drink 0,5 l of hemlock tea three times a day, you can alternate it with other healing infusions, for example, a decoction of eleutherococcus or ginseng. It is very important to remember that hemlock itself is poisonous, therefore it is required to use teas very carefully, not exceeding the above dose.
  4. Clove seeds can reduce the manifestation of an allergic reaction in people with hypersensitivity. They are crushed and 0,5 tsp. use on an empty stomach. You can drink the product with a small amount of water. There is an alternative recipe, which is to mix chopped clove seeds with grated three lemons. The resulting slurry is poured with a liter of boiling water and insisted for 3 days, occasionally shaking. The resulting product is consumed 25 g before each meal for a week.
  5. For external use, ointments are prepared based on pork fat and flowers of the root or arnica. They are crushed and boiled in pre-melted pork fat. Next, the product is insisted in the refrigerator for a day, and applied to the affected skin.

You should not get carried away with alternative methods of treatment, especially in the acute phase of the disease. During remission or when the fever subsides, they can be actively used.

Alternative therapy can be used exclusively as an additional treatment, since it is aimed at eliminating concomitant symptoms, such as pain, parasitic infestations, allergic reactions, etc. Such medicine does not affect the very cause of the development of the disease, so do not self-medicate.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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