Typical Presentations of Acute Vasculitis*
| Clinical problem | Typical features | Differential diagnosis (see also Table 99.3) |
|---|---|---|
(see also Chapter15) | Unaccustomed, severe with tenderness over arteries and scalp. May be accompanied by visual disturbance, jaw or tongue claudication or aches and pains in muscles (polymyalgia). | Widespread causes: for example non-specific headache; cervical spondylosis; shingles; orbital cellulitis. |
Neurological presentation with stroke | Headache Unilateral weakness Speech disturbance | Atherosclerotic stroke Haemorrhagic stroke Sub-arachnoid haemorrhage Malignancy |
Visual loss (see also Chapter19) | Sudden loss of vision in one or both eyes | Non-arteritic ischaemic optic neuropathy Diabetic retinopathy Multiple sclerosis Severe hypertensive retinopathy Infection, for example CMV retinitis |
| Hearing loss | Sudden loss of hearing in one or both ears | Wax Drug toxicity Infection Cholesteatoma Ménière's disease |
(see also Table99.2) | Cough Breathlessness Blood streaked sputum or more florid haemoptysis | Infection Exacerbation of bronchiectasis Anti-coagulant therapy |
Upper respiratory chronic illness (see also Table99.2) | Nasal crusting, hearing loss, sinusitis | Chronic sinusitis; infection; sarcoidosis; midline granuloma |
Systemic illness with chest symptoms (see also Table99.2) | Cough, breathless, haemoptysis with rash or fever or weight loss plus any other feature of active inflammation in different organ systems, for example microscopic haematuria, upper respiratory tract illness | Infection Sarcoidosis Malignancy Drug toxicity Multiple comorbidities |
Acute abdominal pain (see also Chapter 21) | Claudicant ischaemic pain (after food) Blood stained stool/diarrhoea | Drug toxicity Diverticulitis Peptic ulcer Pancreatitis Malignancy Infection Inflammatory bowel disease |
Unexplained renal impairment | Tiredness; anaemia; asymptomatic finding of hypertension and or haematuria and proteinuria | Diabetic nephropathy Obstructive uropathy Hypertensive renal failure Acute sepsis with low volume Drug toxicity |
| Proteinuria | Asymptomatic | Reflux nephropathy Hypertension Infection Minimal change nephropathy |