Aktuelle Rheumatologie 2013; 38(05): 294-299
DOI: 10.1055/s-0032-1323826
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Kutane leukozytoklastische Vaskulitis, Purpura Schönlein-Henoch und kryoglobulinämische Vaskulitis

Cutaneous Leukocytoclastic Vasculitis, Henoch-Schönlein Purpura and Cryoglobulinemic Vasculitis
S. I. Unger
1   Medizinische Klinik II, Sektion Rheumatologie, Universitätsklinikum Leipzig, Leipzig
,
C. Baerwald
1   Medizinische Klinik II, Sektion Rheumatologie, Universitätsklinikum Leipzig, Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
18 October 2012 (online)

Zusammenfassung

Die leukozytoklastische Vaskulitis, Purpura Schönlein-Henoch und kryoglobulinämische Vaskulitis sind Immunkomplexvaskulitiden, die sich durch Ablagerung verschiedener Immunglobuline in den kleinen Gefäßen unterscheiden und sich meist als palpable Purpura klinisch manifestieren. Die differenzialdiagnostische Abgrenzung und die Unterscheidung der primären von sekundären Formen stellt eine Herausforderung für Rheumatologen dar. Die frühzeitige Detektion extrakutaner Organmanifestationen wie Glomerulonephritis, mesenteriale Vaskulitis oder periphere Neuropathie ist für die Therapieindikation und damit die Prognose der Kleingefäßvaskulitiden essentiell.

Abstract

Leukocytoclastic vasculitis, Henoch-Schönlein purpura, cryoglobulinemic vasculitis are defined as immune complex vasculitides and are mediated by deposition of different immunoglobulins in small vessels. Palpable purpura is the most common symptom. Differentiation of the three immune complex vasculitides and secondary forms of vasculitis is challenging for rheumatologists. Early detection of extracutaneous manifestations like glomerulonephritis, mesenterial vasculitis or peripheral neuropathy is essential to initiate appropriate treatment strategies and thereby influencing the prognosis of small-vessel vasculitides.

 
  • Literatur

  • 1 Jennette JC, Falk RJ, Andrassy K et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 1994; 37: 187-192
  • 2 Braun GS, Horster S, Wagner KS et al. Cryoglobulinaemic vasculitis: classification and clinical and therapeutic aspects. Postgrad Med J 2007; 83: 87-94
  • 3 Hospach T, Huppertz HI. Purpura Schönlein-Henoch. Z Rheumatol 2011; 70: 829-837
  • 4 Russell JP, Gibson LE. Primary cutaneous small vessel vasculitis: approach to diagnosis and treatment. Int J Dermatol 2006; 45 (01) 3-13
  • 5 Sunderkötter C, Roth J, Bonsmann G. Leukocytoclastic vasculitis. Hautarzt 2004; 55 (08) 759-783
  • 6 Sunderkötter C, Bonsmann G, Sindrilaru A et al. Management of leukocytoclastic vasculitis. J Dermatolog Treat 2005; 16 (04) 193-206
  • 7 Roberts PF, Waller TA, Brinker TM et al. Henoch-Schönlein Purpura: A Review Article. Southern Medical Journal 2007; 100: 821-824
  • 8 Huppertz HI. Purpura Schönlein-Henoch. Monatsschr Kinderheilkd 2006; 154: 865-871
  • 9 Tedeschi A, Barate C, Minola E et al. Cryoglobulinemia. Blood Reviews 2007; 21: 183-200
  • 10 Unger S, Baerwald C. Leukocytoclastic vasculitis. arthritis+rheuma 2010; 30: 205-210
  • 11 Sohagia AB, Gunturu SG, Tong TR et al. Henoch-Schonlein Purpura-A case report and review of the literature. Gastroenterol Res Pract. 2010 2010. 597-648
  • 12 Jessop SJ. Cutaneous leukocytoclastic vasculitis: a clinical and aetiological study. Br J Rheumatol 1995; 34: 942-945
  • 13 Somer T, Finegold SM. Vasculitides associated with infections, immunization, and antimicrobial drugs. Clin Infect Dis 1995; 20: 1010-1036
  • 14 ten Holder SM, Joy MS, Falk RJ. Cutaneous and systemic manifestations of drug-induced vasculitis. Ann Pharmacother 2002; 36: 130-147
  • 15 Ramos-Casals M, Stone JH, Cid MC et al. The cryoglobulinaemias. Lancet 2012; 379: 348-360
  • 16 Trejo O, Ramos-Casals M, Garcia-Carrasco M et al. Cryoglobulinemia: study of etiologic factors and clinical and immunologic features in 443 patients from a single center. Medicine (Baltimore) 2001; 80: 252-262
  • 17 Brouet JC, Clauvel JP, Danon F et al. Biological and clinical significance of cryoglobulins: a report of 86 cases. Am J Med 1974; 57: 775-788
  • 18 Dammacco F, Sansonno D, Piccoli C et al. The cryoglobulins an overview. Eur J Clin Invest 2001; 31: 628-638
  • 19 Rosa D, Saletti G De Gregorio et al. Activation of naive B lymphocytes via CD81, a pathogenetic mechanism for hepatitis C virus-associated B lymphocyte disorders. Proc Natl Acad Sci USA 2005; 102: 18544-18549
  • 20 Kayali Z, Buckwold VE, Zimmermann B et al. Hepatitis C, cryoglobulinemia, and cirrhosis: a meta-analysis. Hepatology 2002; 36: 978-985
  • 21 Saadoun D, Asselak T, Resche-Rigon M et al. Cryoglobulinemia is associated with steatosis and fibrosis in chronic hepatitis C. Hepatology 2006; 43: 1337-1345
  • 22 Ferri C, La Civita L, Cirafisi C et al. Peripheral neuropathy in mixed cryoglobulinemia: clinical and electrophysiologic investigations. J Rheumatol 1992; 19 (06) 889-895
  • 23 Ferri C, Sebastiani M, Giuggioli D et al. Mixed cryoglobulinemia: demographic, clinical, and serologic features and survival in 321 patients. Seminars Arthritis and Rheumatism 2004; 33: 355-374
  • 24 Invernizzi F, Pietrogrande M, Sagramoso B. Classification of the cryoglobulinemic syndrome. Clin Exp Rheumatol 1995; 13 (Suppl. 13) 123
  • 25 Mukhtyar C, Guillevin L, Cid MC et al. EULAR Recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 2009; 68 (03) 310-317
  • 26 Cacoub P, Saadoun D, Limal N et al. PEGylated interferon alfa-2b and ribavirin treatment in patients with hepatitis C virus-related systemic vasculitis. Arthritis Rheum 2005; 52: 911-915
  • 27 Saadoun D, Resche-Rigon M, Thibault V et al. Antiviral therapy for hepatitis C virus associated mixed cryoglobulinemia vasculitis: a long-term follow-up study. Arthritis Rheum 2006; 54: 3696-3706
  • 28 Callen JP, Ekenstam E. Cutaneous leukocytoclastic vasculitis: clinical experience in 44 patients. South Med J 1987; 80: 848-851
  • 29 Pyne D, Mootoo R, Bhanji A. Colchicine for the treatment of recurrent Henoch-Schonlein Purpura in an adult. Rheumatology (Oxford) 2001; 40: 1430-1431
  • 30 Ruiz Villaverde R, Blasco Melguizo J, Martin Sanchez MC et al. Annular leukocytoclastic vasculitis: response to dapsone. J Eur Acad Dermatol Venereol 2002; 16: 544-546
  • 31 Mahr A, Chaigne-Delalande S, De Menthon M. Therapeutic plasma exchange in systemic vasculitis: an update on indications and results. Curr Opin Rheumatol 2012; 24 (03) 261-266
  • 32 Chandesris MO, Gayet S, Schleinitz N et al. Infliximab in the treatment of refractory vasculitis secondary to hepatitis C-associated mixed cryoglobulinaemia. Rheumatology (Oxford) 2004; 43: 532-533
  • 33 Dede F, Onec B, Ayli D et al. Mycophenolate mofetil treatment of crescentic Henoch-Schönlein nephritis with IgA depositions. Scand J Urol Nephrol 2008; 42 (02) 178-180
  • 34 Nikibakhsh AA, Mahmoodzadeh H, Karamyyar M et al. Treatment of complicated Henoch-Schönlein purpura with mycophenolate mofetil: a retrospective case series report. Int J Rheumatol. 2010 2010. 254-316
  • 35 Uthman IW, Touma Z, Sayyad J et al. Response of deep cutaneous vasculitis to infliximab. J Am Acad Dermatol 2005; 53: 353-354
  • 36 Bryce AH, Dispenzieri A, Kyle RA et al. Response to rituximab in patients with type II cryoglobulinemia. Clin Lymphoma Myeloma 2006; 7: 140-144
  • 37 De Vita S, Quartuccio L, Isola M et al. A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis. Arthritis Rheum 2012; 64 (03) 843-853
  • 38 Ferri C, Cacoub P, Mazzaro C et al. Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: results of multicenter cohort study and review of the literature. Autoimmun Rev 2011; 11 (01) 48-55
  • 39 Lamprecht P, Lerin-Lozano C, Merz H et al. Rituximab induces remission in HCV-associated cryoglobulinemic vasculitis. Ann Rheum Dis 2003; 62: 1230-1233
  • 40 Quartuccio L, Soardo G, Romano G et al. Rituximab treatment for glomerulonephritis in HCV associated mixed cryoglobulinemia: efficacy and safety in the absence of steroids. Rheumatology 2006; 45: 842-846
  • 41 Sneller MC, Hu Z, Langford CA. A randomized controlled trail of rituximab following failure of antiviral therapy for hepatitis C virus-associated cryoglobulinemic vasculitis. Arthritis Rheum 2012; 64 (03) 835-842
  • 42 Zaja F, De Vita S, Mazzaro C et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003; 101: 3827-3834
  • 43 Mohan N, Edwards ET, Cupps TR et al. Leukocytoclastic vasculitis associated with tumor necrosis factor-alpha blocking agents. J Rheumatol 2004; 31: 1955-1958
  • 44 Trendelenburg M, Fossati-Jimack I, Cortes-Hernandez J et al. The role of complement in cryoglobulin-induced immune complex glomerulonephritis. J Immunol 2005; 175: 6909-6914