[Medium and large vessel vasculitis]

An ayurvedic approach in the management of Siragatavata complicated with Dusta Vrana

Vasculitis is chronic inflammation resulting in necrosis of blood vessels due to narrowing or occlusion of the lumen. Here we present a case of 28 yrs old woman suffering from medium size vessel vasculitis since childhood. The patient had purulent skin lesions at lateral aspect of lower limbs, fatigue and pain all over the body. There was complaint of bluish discoloration of extremities, especially in winter season. The patients had history of similar skin lesions in past which were treated by allopathic treatment, but this treatment failed in meeting the expectations of patient. These lesions were not responding to the contemporary treatment since a year. The Ayurvedic diagnosis of the case was established as Siragatavata complicated with Dusta Vrana (~infected wound). She was treated with Vrana Prakshalana (doucing of skin ulceration) with Triphala Kwath for initial 15 days followed by Virechan Karma (purgation therapy) with Tilvaka Ghrita in 20 g dose. Erandmooladi Niruha Basti (enema mainly with decoction) with Bala Taila (oil) Anuvasan Basti (enema with oil) for eight days in Yoga Basti Krama (eight days order of enema) was administered after Virechana Karma. The Ayurvedic oral drugs [Ashwagandhaveleha-10 g, Jwarhar Kashaya- 40 ml, Shatavari Churna (powder)-3 gm, Vidanga Churna-2 g Kaishor Guggulu-500mg and Shilajatwadi Loha-500mg] twice a day for 12 months were also administered in the case. Skin lesions healed after a month of treatment and there was no relapse in more than 18months follow up. Patient was lean and thin and underweight at the beginning of the treatment. There was 4 Kg increase in weight during the treatment. There were no complaints of paresthesia, pain and fatigue after 18 months of treatment. No bluish discoloration was noted during this period. Presently patient is stable with Ayurvedic medications. The case study shows that medium size vessels vasculitis may be managed with Panchakarma procedures and Ayurvedic medication with satisfactory outcome. However, large sample studies are required for definitive conclusion.

Intragraft vasculitis and gene expression analysis: Association with acute rejection and prediction of mortality in long-term heart transplantation

INTRODUCTION

Vasculitis entails heterogeneous origins; it starts with an inflammatory process that leads to small vessels' necrosis, hemorrhage, and ischemic lesion, and may further result in occlusion of the vascular lumen. Vasculitis' contribution to allograft rejection is still unclear. This study aims to investigate the incidence of vasculitis in the early stages of heart transplantation as well as to assess the intragraft genes' expression associated with vascular function and subsequently to verify the way in which it affects the outcome of the allograft.

METHODS

In this retrospective study, 300 archive paraffin-embedded endomyocardial biopsies from 63 heart allograft recipients were assessed. Cellular rejection and vasculitis were diagnosed through histological analysis, and antibody-mediated rejection was performed with immunohistochemical C4d staining. The transcripts of ICAM, VCAM, VEGF, CCL2, IFNG, TGFB, TNF, ADIPOR1, and ADIPOR2 genes were examined through quantitative polymerase chain reaction using B2M for normalization.

RESULTS

We observed a higher prevalence of severe vasculitis in the early period of post-transplant, and recovery was observed to take place around 1 year post-transplant. Additionally, vasculitis was found to be directly associated with acute cellular rejection and antibody-mediated rejection. The intense C4d capillary positivity predicts higher long-term cardiovascular disease mortality. In comparison with the vasculitis-free group, the group with severe vasculitis displayed reduced left ventricular ejection fraction and an upregulation of VCAM and IFNG associated with the downregulation of VEGF, ADIPOR1, and ADIPOR2.

CONCLUSION

The vasculitis associated with the presence of C4d and the change in intragraft gene expression profile may contribute to poor allograft outcomes.

Churg-Strauss Syndrome or Eosinophilic Granulomatosis with Polyangiitis: Exuberant Classic Clinical Picture of a Rare Disease

The authors present a classic case of Churg-Strauss syndrome with an exuberant clinical picture in a 34-year-old woman. She showed the following diagnostic criteria: asthma, polyneuropathy, rhinopathy, marked eosinophilia, positive p-ANCA with a perinuclear pattern, and skin histopathology results suggestive of vasculitis with eosinophils. There was a good response to prednisone, dexamethasone pulse therapy, and cyclophosphamide.

Granuloma faciale: a good therapeutic response with the use of topical tacrolimus

Granuloma faciale is a rare dermatosis of chronic course, benign, usually asymptomatic, first described in 1945 by Wingley. It is characterized by the appearance of well-defined, single or multiple papules, plaques and nodules, predominantly located in sun-exposed areas, especially the face. In this work we report the case of a female patient, 58 years old, evolving for ten years with multiple erythematous-brownish and asymptomatic papules on the face, whose histological examination confirmed the diagnosis of granuloma faciale. The patient was treated with topical tacrolimus, evolving with regression of lesions.

Granulomatosis with polyangiitis, a new nomenclature for Wegener's Granulomatosis--Case report

The granulomatosis with polyangiitis, initially known as Wegener's granulomatosis, is a small and medium vessels vasculitis. It's classic form presents a triad: necrotizing granuloma of respiratory tract, necrotizing cutaneous vasculitis and glomerulonephritis. This vasculitis has cytoplasmic antineutrophil antibodies as signal. This work illustrates a case, of multisystemic rare disease, in which the segment and treatment were considered satisfactory for symptoms remission.