Match each patient's clinical presentation with the most likely histopathologic or defining structural finding associated with their underlying condition.
- A 72-year-old woman with a new-onset severe unilateral headache, pain in her jaw muscles when chewing, and an episode of transient monocular vision loss.Granulomatous inflammation of the vessel media with fragmentation of the internal elastic lamina
- A 45-year-old man with recent-onset testicular pain, severe postprandial abdominal pain, and right-sided wrist drop; serologies are negative for ANCA.Segmental, transmural necrotizing inflammation of medium-sized arteries with sparing of the pulmonary circulation
- A 38-year-old man with a history of recurrent sinusitis presenting with hemoptysis, saddle-nose deformity, and hematuria with red blood cell casts.Necrotizing granulomatous inflammation of small vessels with associated pauci-immune glomerulonephritis
- A 7-year-old boy presenting with palpable purpura on the lower extremities, intermittent colicky abdominal pain, and knee arthralgias following a viral infection.Leukocytoclastic vasculitis with prominent IgA and C3 immune complex deposition in small vessels
Answer
Giant Cell Arteritis matches with granulomatous inflammation and elastic lamina fragmentation. Polyarteritis Nodosa matches with transmural necrotizing inflammation of medium arteries. Granulomatosis with Polyangiitis matches with necrotizing granulomatous small vessel inflammation. IgA Vasculitis matches with IgA/C3 leukocytoclastic vasculitis.
Systemic vasculitides are classified by the primary size of the blood vessels affected and their underlying histopathology. The older woman presents with classic Giant Cell Arteritis, a large-vessel condition characterized by granulomatous inflammation and elastic lamina fragmentation. The middle-aged man displays features of Polyarteritis Nodosa, a medium-vessel disease leading to microaneurysms and tissue ischemia (sparing the lungs). The young man with the saddle-nose deformity has Granulomatosis with Polyangiitis, uniquely presenting with upper/lower respiratory granulomas and renal disease. Finally, the child has IgA Vasculitis, driven by immune complex deposition in small vessels.
Step-by-Step Solution
Key Concept
Correlation of clinical presentations with histopathologic findings across large, medium, and small vessel systemic vasculitides.
Estimated Time:1m 30s