VASCULITIS. A TEN YEAR STUDY AT THE INSTITUTO NACIONAL DE PEDIATRÍA, DEPARTEMENT OF INTERNAL MEDICINE

Carbajal RL, Luna FM, Reynés MJ, Rodríguez HR, Barrios FR, Zarco RJ.

Instituto Nacional de Pediatría. SS

Mexico City, Mexico

 

Objective: To know the incidence of vasculitis in a third level institution.

Material and Method: 125 patients with primary vasculitis seen at the Department of Internal Medicine of the Instituto Nacional de Pediatría (National Institute of Pediatrics) from 1978 to 1998 were studied. The diagnosis was based on the American College of Rheumatology criteria. Only the patients who met the criteria were included.

Results: Age of patients with the diagnosis of vasculitis ranged from 1 to 17 years 6 months (mean 6 years 1 month); 66 were female and 59 male; ratio 1.1:1. Four of the most common vasculitis were found: Henoch-Schönlein purpura. 109 patients; 59 percent female, 44.1 percent male; 1.2:1 ratio; mean age 6 years 3 months. All the patients (100 percent) presented with two or more diagnostic criteria; 4 patients had four criteria (3.6 percent); 84 (77 percent) had three criteria. Four renal biopsies reported segmentary intracapillary glomerulonephritis in two, slight proliferative intracapillary glomerulonephritis in one, segmental focal glomerulonephritis and focal interstitial nephritis in another one. Kawasaki’s disease. 9 patients; 5 male, 4 female; mean age, 3 years 11 months. All the patients presented with fever above 38° C for more than 5 days, conjunctivitis and maculopapulous erythema; dry lips with fissures and hyperemic mucosae in 88.8 percent (8 patients); cervical adenopathies larger than 0.5 cm in 77.7 percent (7 patients); hand and feet induration, palmar and plantar erythema in 66.6 percent (6 patients); strawberry tongue, 44.4 percent (4 patients); hand and feet desquamation, 44.4 percent (4 patients). Polyarteritis nodosa. 6 patients; all male; mean age, 1 year 11 months. Diastolic blood pressure was above 90 mmHg in 100 percent (6 patients); renal and mesenteric arterial microaneurysms, 83.3 percent (5 patients); hyperazotemia, 66.6 percent (4 patients); weight loss of more than 4 kg, 50 percent (3 patients); livedo reticularis in 33.3 percent (2 patients); mononeuropathy, 16.6 percent (1 patient). Takayasu’s disease. One patient, 14 years old who presented with diminished brachial artery pulse; celiac and iliac arteries lesions, dilatation of the aorta and irregular renal arteries.

Conclusions: Vasculitis diseases are often seen in third level institutions. Henoch-Schönlein purupura is the most frequent, whereas other reports indicate that Kawasaki’s disease is more common. In our study it was the second most common vasculitis. For many years polyarteritis was believed to be a disease of adults; however it also occurrs in children. The same is true for Takayasu’s disease, although it is prevalent in adults.

 

 

 
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