Childhood Vasculitis

Abstract

The term vasculitis covers heterogeneous disorders that share the presence of inflammation of blood vessel walls. Immune cell infiltrates can vary significantly and involve granulocytes or mononuclear cells. Vasculitis can be a symptom of other underlying disorders or the underlying cause of organ specific or systemic disease. Classification of childhood vasculitis is based on clinic, the size of predominantly affected vessels, and the histopathology of inflammatory infiltrates. Timely and accurate diagnosis and (where necessary) treatment initiation determine disease progression and outcomes. In light of new developments and the identification of autoinflammatory conditions with vasculitis, new classification tools may be discussed.

Keywords: classification; granulomatosis with polyangitis; inflammation; kawasaki disease; paediatric; purpura; systemic disease; vasculitis.

Figure 1

Classification of primary childhood vasculitis based on revised Chapel Hill criteria (2012) and the EULAR/PRES classification (–5).

Figure 2

Takayasu arteritis in a 12-year-old girl. (A) MRI angiography showing significant stenosis of the coeliac truncus (*) and lower aorta (→); artifacts are caused by stent implants in renal arteries (L) (provided by Dr. Gabriele Hahn, Pädiatrische Radiologie, Universitätsklinikum Carl Gustav Carus, TU Dresden), (B) transversal abdominal ultrasonography indicating significant stenosis of the coeliac truncus, (C) Stenosis of coeliac truncus resulting in pathologically increased arterial blood flow velocity (provided by Dr. Heike Taut, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden). Consent of the patient was obtained to publish these images.

Figure 3

Clinical criteria in KD. (A) Bilateral non-purulent conjunctivitis (80–90%), (B) changes to oropharyngeal mucous membranes, including injected and/or fissured lips, strawberry tongue (80–90%), (C) Palmar, and/or (D) plantar erythema (E) polymorphous exanthema, primarily truncal, not vesicular (>90%), and (F,G) cervical lymphadenopathy (>1.5 cm) (50%). (G) Ultrasound of enlarged cervical lymph nodes with increased perfusion (provided by Dr. Heike Taut, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden). (H) Periungual desquamation (in covalescent phase) (80%), (I) Beau lines; images from (22).

Figure 4

Pro-inflammatory mechanisms in immune complex vasculitis.

Figure 5

Findings in a 16-year-old boy with GPA. (A) Abdominal MRI showing pronounced parenchymatous necrosis of the spleen with distension of the spleen capsule (provided by Dr. Gabriele Hahn, Pädiatrische Radiologie, Universitätsklinikum Carl Gustav Carus, TU Dresden); (B) Necrotizing skin vasculitis on legs and feet; (C) Splenomegaly, spleen with increased echogenicity, subcapsular fluid accumulation, hypoechogenic necrotic areas with absence of perfusion (provided by Dr. Heike Taut, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden); (D) Severe enterocolitis (shown: transversal colon) with deep ulcerations as a result of necrotizing vasculitis (provided by Dr. Martin Laass, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden). Consent of the patient was obtained to publish these images.