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Discussion Starter · #1 ·
A 38-year-old female presents with the new onset of multiple purpuric skin lesions. Two years ago she developed late-onset asthma and mild hypertension. Laboratory examination reveals an increase in the number of eosinophils in the peripheral blood (peripheral eosinophilia), and a biopsy from one of the purpuric skin lesions reveals leukocytoclastic vasculitis. No perivascular IgA deposits are found, and no antineutrophil cytoplasm autoantibodies are present. Which one of the listed disorders is the best diagnosis for this individual?


a. Churg-Strauss syndrome
b. Henoch-Schönlein purpura
c. Macroscopic polyarteritis nodosa
d. Microscopic polyangiitis
e. Wegener’s granulomatosis
 

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my asnwer A

Clue : Eosinophilia ( 2 posible options: PAN or Churg S.)

but in PAN , there is renal disease , HBV associated and NO ashtma

In churg strauss the classic triad: late onset of asthma, hypertension and eosinophilia are more relevant than "no antineutrophil cytoplasm autoantibodies" that in this case is negative
 

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A 38-year-old female presents with the new onset of multiple purpuric skin lesions. Two years ago she developed late-onset asthma and mild hypertension. Laboratory examination reveals an increase in the number of eosinophils in the peripheral blood (peripheral eosinophilia), and a biopsy from one of the purpuric skin lesions reveals leukocytoclastic vasculitis. No perivascular IgA deposits are found, and no antineutrophil cytoplasm autoantibodies are present. Which one of the listed disorders is the best diagnosis for this individual?

a. Churg-Strauss syndrome
b. Henoch-Schönlein purpura
c. Macroscopic polyarteritis nodosa
d. Microscopic polyangiitis
e. Wegener's granulomatosis
a. Churg-Strauss syndrome
Asthma----eosinophilia---purpuric skin
 

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Discussion Starter · #9 ·
A is correct

Leukocytoclastic angiitis refers to the histologic finding of fragmented neutrophils surrounding small blood vessels. The differential diagnosis of leukocytoclastic vasculitis includes microscopic polyarteritis nodosa and three other disorders: Henoch-Schönlein purpura, Wegener's granulomatosis, and Churg-Strauss syndrome. Henoch- Schönlein purpura is a disorder of children who present with hemorrhagic urticaria and hematuria following an upper respiratory infection. The pathology of this disease involves the deposition of IgA immune complexes
in small vessels of the skin. Because the antibody is IgA, the alternate
complement pathway is activated in these patients. Wegener's
granulomatosis (WG) is characterized by acute necrotizing granulomas of
the upper and lower respiratory tract, focal necrotizing vasculitis affecting
small to medium-sized vessels, and renal disease. Histologically there is
fibrinoid necrosis of small arteries, early infiltration by neutrophils, and
granuloma formation with giant cells. The peak incidence is in the fifth
decade, and many patients have C-ANCAs. The disease is highly fatal,
with death occurring within 1 year, unless recognized and treated with
immunosuppressive agents. Churg-Strauss syndrome (allergic vasculitis)
is a form of necrotizing vasculitis with granulomas of the respiratory tract
and asthma. The disorder is associated with increased serum IgE and
peripheral eosinophilia.
 

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A 38-year-old female presents with the new onset of multiple purpuric skin lesions. Two years ago she developed late-onset asthma and mild hypertension. Laboratory examination reveals an increase in the number of eosinophils in the peripheral blood (peripheral eosinophilia), and a biopsy from one of the purpuric skin lesions reveals leukocytoclastic vasculitis. No perivascular IgA deposits are found, and no antineutrophil cytoplasm autoantibodies are present. Which one of the listed disorders is the best diagnosis for this individual?

a. Churg-Strauss syndrome
b. Henoch-Schönlein purpura
c. Macroscopic polyarteritis nodosa
d. Microscopic polyangiitis
e. Wegener's granulomatosis
Ans: a-Churg-Strauss syndrome
 
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