**Author details**

Christina G. Katsiari1 , Theodora Simopoulou1 and Lazaros I. Sakkas1,2\*

\*Address all correspondence to: lsakkas@med.uth.gr

1 Rheumatology Clinic, School of Medicine, Faculty of Health Sciences, University of The‐ ssaly, Larissa, Greece

2 Center of Molecular Medicine,Old Dominion University, Norfolk, VA, USA

### **References**


[5] Alric L, Plaisier E, Thebault S, Peron JM, Rostaing L, Pourrat J, Ronco P, Piette JC, Cacoub P. Influence of antiviral therapy in hepatitis C virus-associated cryoglobuli‐ nemic MPGN. American Journal of Kidney Diseases 2004; 43: 617-623.

combined therapy of hepatitis C virus-related mixed cryoglobulinemia: a long-term

Treatment of ANCA-Negative Small Vessel Vasculitis

http://dx.doi.org/10.5772/54272

233

[17] Sneller MC, Hu Z, Langford CA. A randomized controlled trial of rituximab follow‐ ing failure of antiviral therapy for hepatitis C-associated cryoglobulinemic vasculitis.

[18] Landau DA, Saadoun D, Halfon P, Martinot-Peignoux M, Marcellin P, Fois E, Ca‐ coub P. Relapse of hepatitis C virus-associated mixed cryoglobulinemia vasculitis in patients with sustained viral response. Arthritis and Rheumatism 2008; 58: 604-611.

[19] Guillevin L, Pagnoux C. Indications of plasma exchanges for systemic vasculitides. Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Di‐

[20] Ramos-Casals M, Font J. Mycophenolate mofetil in patients with hepatitis C virus in‐

[21] Lamprecht P, Gause A, Gross WL. Cryoglobulinemic vasculitis. Arthritis and Rheu‐

[22] Vassilopoulos D, Calabrese LH. Hepatitis C virus infection and vasculitis: implica‐ tions of antiviral and immunosuppressive therapies. Arthritis and Rheumatism 2002;

[23] De Vita S, Quartuccio L. Rituximab monotherapy, rather than rituximab plus antivi‐ ral drugs, for initial treatment of severe hepatitis C virus-associated mixed cryoglo‐ bulinemia syndrome: comment on the article by Terrier et al. Arthritis and

[24] Guilera M, Forns X, Torras X, Enriquez J, Coll S, Solá R, Morillas R, Planas R, Ampur‐ danes S, Soler M. Pre-treatment with prednisolone does not improve the efficacy of subsequent alpha interferon therapy in chronic hepatitis C. Journal of Hepatology

[25] Tarantino A, Moroni G, Banfi G, Manzoni C, Segagni S, Ponticelli C. Renal replace‐ ment therapy in cryoglobulinaemic nephritis. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association-European

[26] Saadoun D, Landau DA, Calabrese LH, Cacoub PP. Hepatitis C-associated mixed cryoglobulinaemia: a crossroad between autoimmunity and lymphoproliferation.

[27] Valbonesi M, Florio G, Montani F, Mosconi L. A method for the study of cryoglobu‐ lin solubilization curves at 37 degrees C. Preliminary studies and application to plas‐ ma exchange in cryoglobulinemic syndromes. The International Journal of Artificial

study. Blood 2010; 116: 343-353.

alysis Therapy 2003; 7: 155-160.

fection. Lupus 2005; 14: s64-s72.

Rheumatism 2009; 60: 2531-2540.

Renal Association 1994; 9: 1426-1430.

Rheumatology (Oxford, England) 2007; 46: 1234-1242.

matism 1999; 42: 2507-2516.

46: 585-597.

2000; 33: 135-141.

Organs 1983; 6: 87-90.

Arthritis and Rheumatism 2012; 64: 835-842.


combined therapy of hepatitis C virus-related mixed cryoglobulinemia: a long-term study. Blood 2010; 116: 343-353.

[17] Sneller MC, Hu Z, Langford CA. A randomized controlled trial of rituximab follow‐ ing failure of antiviral therapy for hepatitis C-associated cryoglobulinemic vasculitis. Arthritis and Rheumatism 2012; 64: 835-842.

[5] Alric L, Plaisier E, Thebault S, Peron JM, Rostaing L, Pourrat J, Ronco P, Piette JC, Cacoub P. Influence of antiviral therapy in hepatitis C virus-associated cryoglobuli‐

[6] Zuckerman E, Keren D, Slobodin G, Rosner I, Rozenbaum M, Toubi E, Sabo E, Tsy‐ kounov I, Naschitz JE, Yeshurun D. Treatment of refractory, symptomatic, hepatitis C virus related mixed cryoglobulinemia with ribavirin and interferon-alpha. The

[7] Saadoun D, Resche-Rigon M, Thibault V, Piette JC, Cacoub P. Antiviral therapy for hepatitis C virus--associated mixed cryoglobulinemia vasculitis: a long-term follow‐

[8] Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, De Groot K, Gross W, Hauser T, Hellmich B, Jayne D, Kallenberg CG. EULAR recommendations for the management of primary small and medium vessel vasculitis. Annals of the Rheumatic Diseases

[9] Cacoub P, Saadoun D, Limal N, Sene D, Lidove O, Piette JC. PEGylated interferon alfa-2b and ribavirin treatment in patients with hepatitis C virus-related systemic

[10] Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treat‐

[11] Joshi S, Kuczynski M, Heathcote EJ. Symptomatic and virological response to antivi‐ ral therapy in hepatitis C associated with extrahepatic complications of cryoglobuli‐

[12] Zaja F, De Vita S, Mazzaro C, Sacco S, Damiani D, De Marchi G, Michelutti A, Bac‐ carani M, Fanin R, Ferraccioli G. Efficacy and safety of rituximab in type II mixed

[13] Sansonno D, De Re V, Lauletta G, Tucci FA, Boiocchi M, Dammacco F. Monoclonal antibody treatment of mixed cryoglobulinemia resistant to interferon alpha with an

[14] Saadoun D, Resche RM, Sene D, Terrier B, Karras A, Perard L, Schoindre Y, Coppere B, Blanc F, Musset L. Rituximab plus Peg-interferon-alpha/ribavirin compared with Peg-interferon-alpha/ribavirin in hepatitis C-related mixed cryoglobulinemia. Blood

[15] Quartuccio L, Soardo G, Romano G, Zaja F, Scott CA, De Marchi G, Fabris M, Ferrac‐ cioli G, De Vita S. Rituximab treatment for glomerulonephritis in HCV-associated mixed cryoglobulinaemia: efficacy and safety in the absence of steroids. Rheumatolo‐

[16] Dammacco F, Tucci FA, Lauletta G, Gatti P, De Re V, Conteduca V, Sansonno S, Rus‐ si S, Mariggio MA, Chironna M. Pegylated interferon-alpha, ribavirin, and rituximab

nemic MPGN. American Journal of Kidney Diseases 2004; 43: 617-623.

Journal of Rheumatology 2000; 27: 2172-2178.

2009; 68: 310-317.

232 Updates in the Diagnosis and Treatment of Vasculitis

up study. Arthritis and Rheumatism 2006; 54: 3696-3706.

vasculitis. Arthritis and Rheumatism 2005; 52: 911-915.

mia. Digestive Diseases and Sciences 2007; 52: 2410-2417.

cryoglobulinemia. Blood 2003; 101: 3827-3834.

anti-CD20. Blood 2003; 101: 3818-3826.

2010; 116: 326-334.

gy (Oxford) 2006; 45: 842-846.

ment of hepatitis C: An update. Hepatology 2009; 49: 1335-1374.


[28] Sohagia AB, Gunturu SG, Tong TR, Hertan HI. Henoch-Schonlein Purpura-a case re‐ port and review of the literature. Gastroenterology Research and Practice 2010; 2010 DOI: 10.1155/2010/597648.

tion: official publication of the European Dialysis and Transplant Association-Euro‐

Treatment of ANCA-Negative Small Vessel Vasculitis

http://dx.doi.org/10.5772/54272

235

[41] Oner A, Tinaztepe K, Erdogan O. The effect of triple therapy on rapidly progressive type of Henoch-Sch+¦nlein nephritis. Pediatric nephrology (Berlin, Germany) 1995; 9:

[42] Lijima K, Ito- Kariya S, Nakamura H, Yoshikawa N. Multiple combined therapy for severe Henoch- Schonlein nephritis in children. Pediatric Nephrology 1998; 12(3):

[43] Pillebout E, Alberti C, Guillevin L, Ouslimani A, Thervet E, LESAR study group. Ad‐ dition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Scholein purpura. Kidney Inter‐

[44] Jauhola O, Ronkainen J, Autio-Harmainen H, Koskimies O, Ala-Houhala M, Arikoski P, Holtta T, Jahnukainen T, Rajantie J, Ormala T. Cyclosporine A vs. methylpredniso‐ lone for Henoch-Schonlein nephritis: a randomized trial. Pediatric Nephrology (Ber‐

[45] Shin JI, Park JM, Shin YH, Kim JH, Kim PK, Lee JS, Jeong HJ. Cyclosporin A therapy for severe Henoch-Schonlein nephritis with nephrotic syndrome. Pediatric Nephrolo‐

[46] Shin JI, Park JM, Shin YH, Kim JH, Lee JS, Jeong HJ. Henoch-Schonlein purpura nephritis with nephrotic-range proteinuria: histological regression possibly associat‐ ed with cyclosporin A and steroid treatment. Scandinavian Journal of Rheumatology

[47] Park JM, Won SC, Shin JI, Yim H, Pai KS. Cyclosporin A therapy for Henoch-Sch +¦nlein nephritis with nephrotic-range proteinuria. Pediatric Nephrology (Berlin,

[48] Ronkainen J, Autio-Harmainen H, Nuutinen M. Cyclosporin A for the treatment of severe Henoch-Schonlein glomerulonephritis. Pediatric Nephrology (Berlin, Germa‐

[49] Kalliakmani P, Benou E, Goumenos DS. Cyclosporin A in adult patients with He‐ noch-Schonlein purpura nephritis and nephrotic syndrome; 5 case reports. Clinical

[50] Bergstein J, Leiser J, Andreoli SP. Response of crescentic Henoch-Schoenlein purpura nephritis to corticosteroid and azathioprine therapy. Clinical Nephrology 1998; 49:

[51] Singh S, Kumar L, Joshi K, Minz RW, Datta U. Severe Henoch-Schonlein nephritis: resolution with azathioprine and steroids. Rheumatology International 2002; 22:

pean Renal Association 2004; 19: 858-64.

6-10.

244-248

national 2010; 78(5):495- 502

lin, Germany) 2011;26 (12):2159-66.

gy (Berlin, Germany) 2005; 20: 1093-7

2005; 34: 392-395.

Germany) 2011; 26: 411-7

ny) 2003; 18: 1138-42.

9.-14

133-7.

Nephrology 2011; 75: 380-3.


tion: official publication of the European Dialysis and Transplant Association-Euro‐ pean Renal Association 2004; 19: 858-64.

[41] Oner A, Tinaztepe K, Erdogan O. The effect of triple therapy on rapidly progressive type of Henoch-Sch+¦nlein nephritis. Pediatric nephrology (Berlin, Germany) 1995; 9: 6-10.

[28] Sohagia AB, Gunturu SG, Tong TR, Hertan HI. Henoch-Schonlein Purpura-a case re‐ port and review of the literature. Gastroenterology Research and Practice 2010; 2010

[29] Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schonlein purpura: a systematic review. Pediatrics 2007; 120: 1079.

[30] Ronkainen J, Koskimies O, Ala-Houhala M, Antikainen M, Merenmies J, Rajantie J, Ormala T, Turtinen J, Nuutinen M. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, double-blind, placebo-controlled trial. The Journal of Pedia‐

[31] Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-control‐ led trial of prednisone in early Henoch Schonlein Purpura. BMC Medicine 2004; 2: 7.

[32] Zaffanello M, Brugnara M, Franchini M. Therapy for children with henoch-schonlein purpura nephritis: a systematic review. The Scientific World Journal 2007; 7: 20.

[33] Besbas N, Duzova A, Topaloglu R, Gok F, Ozaltin F, Ozen S, Bakkaloglu A. Pulmo‐ nary haemorrhage in a 6-year-old boy with Henoch-Schonlein purpura. Clinical

[34] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treat‐ ment of renal disease in Henoch-Schonlein purpura: a systematic review. Archives of

[35] Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of He‐ noch-Schonlein Purpura glomerulonephritis in children with high-dose corticoste‐ roids plus oral cyclophosphamide. American Journal of Nephrology 2001; 21:

[36] Gibson KL, Amamoo MA, Primack WA. Corticosteroid therapy for Henoch Schon‐

[37] Niaudet P, Habib R. Methylprednisolone pulse therapy in the treatment of severe forms of Schonlein-Henoch purpura nephritis. Pediatric Nephrology (Berlin, Germa‐

[38] Tanaka H, Suzuki K, Nakahata T, Ito E, Waga S. Early treatment with oral immuno‐ suppressants in severe proteinuric purpura nephritis. Pediatric Nephrology (Berlin,

[39] Tarshish P, Bernstein J, Edelmann Jr CM. Henoch-Schonlein purpura nephritis: course of disease and efficacy of cyclophosphamide. Pediatric Nephrology (Berlin,

[40] Kawasaki Y, Suzuki J, Suzuki H. Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch-Schoenlein nephritis: a clinical and histopathological study. Nephrology, dialysis, transplanta‐

DOI: 10.1155/2010/597648.

234 Updates in the Diagnosis and Treatment of Vasculitis

trics 2006; 149: 241-7.

Rheumatology 2001; 20: 293-6.

128-133.

ny) 1998; 12: 238-43.

Germany) 2003; 18: 347-50.

Germany) 2004; 19: 51-6.

Disease in Childhood 2009; 94: 132-7.

lein purpura. Pediatrics 2008; 121: 870-1.


[52] Foster BJ, Bernard C, Drummond KN, Sharma AK. Effective therapy for severe He‐ noch-Schonlein purpura nephritis with prednisone and azathioprine: a clinical and histopathologic study. The Journal of Pediatrics 2000; 136: 370-5.

[64] Wortmann SB, Fiselier TJ, Van De Kar NC, Aarts RA, Warris A, Draaisma JM. Refrac‐ tory severe intestinal vasculitis due to Henoch-Sch+¦nlein purpura: successful treat‐ ment with plasmapheresis. Acta Paediatrica (Oslo, Norway: 1992) 2006; 95(5): 622-3.

Treatment of ANCA-Negative Small Vessel Vasculitis

http://dx.doi.org/10.5772/54272

237

[65] Hattori M, Ito K, Konomoto T, Kawaguchi H, Yoshioka T, Khono M. Plasmapheresis as the sole therapy for rapidly progressive Henoch-Schonlein purpura nephritis in children. American journal of kidney diseases: the official journal of the National

[66] Shenoy M, Ognjanovic MV, Coulthard MG. Treating severe Henoch-Schonlein and IgA nephritis with plasmapheresis alone. Pediatric Nephrology (Berlin, Germany)

[67] Aries PM, Hellmich B, Gross WL. Intravenous immunoglobulin therapy in vasculitis: speculation or evidence? Clinical Reviews in Allergy & Immunology 2005; 29: 237-45.

[68] Kusuda A, Migita K, Tsuboi M, Degawa M, Matsuoka N, Tominaga M, Kawakami A, Kawabe Y, Taguchi T, Eguchi K. Successful treatment of adult-onset Henoch-Schon‐ lein purpura nephritis with high-dose immunoglobulins. Internal Medicine (Tokyo,

[69] Rostoker G, Desvaux-Belghiti D, Pilatte Y, Petit-Phar M, Philippon C, Deforges L, Terzidis H, Intrator L, Andre C, Adnot S. Immunomodulation with low-dose immu‐ noglobulins for moderate IgA nephropathy and Henoch-Schonlein purpura. Prelimi‐

[70] Davin JC. Henoch-Schonlein Purpura Nephritis: Pathophysiology, Treatment, and Future Strategy. Clinical journal of the American Society of Nephrology: CJASN

[71] Inoue CN, Matsutani S, Ishidoya M, Homma R, Chiba Y, Nagasaka T. Periodontal and ENT Therapy in the Treatment of Pediatric Henoch-Schonlein Purpura and IgA

[72] Kanai H, Sawanobori E, Kobayashi A, Matsushita K, Sugita K, Higashida K. Early Treatment with Methylprednisolone Pulse Therapy Combined with Tonsillectomy for Heavy Proteinuric Henoch-Schonlein Purpura Nephritis in Children. Nephron

[73] Ohara S, Kawasaki Y, Matsuura H, Oikawa T, Suyama K, Hosoya M. Successful ther‐ apy with tonsillectomy for severe ISKDC grade VI Henoch-Schonlein purpura neph‐ ritis and persistent nephrotic syndrome. Clinical and ExperimentalNephrology

[74] Szer IS, Pierce H. Henoch-Schonlein purpura. In Rheumatology, Hochberg ed. Elsev‐

[75] Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology 2010;

Nephropathy. Advances in Oto-rhino-laryngology 2011; 72: 53-6.

nary results of a prospective uncontrolled trial. Nephron 1995; 69: 327-334.

Kidney Foundation 1999; 33(3): 427-33

2007; 22: 1167-71.

Japan) 1999; 38: 376-9.

2011;6(3):67-89.

Extra 2011; 1: 101-111.

2011;15(5):749-53

ier; 2011: 1587-1595.

56: 3-23.


[64] Wortmann SB, Fiselier TJ, Van De Kar NC, Aarts RA, Warris A, Draaisma JM. Refrac‐ tory severe intestinal vasculitis due to Henoch-Sch+¦nlein purpura: successful treat‐ ment with plasmapheresis. Acta Paediatrica (Oslo, Norway: 1992) 2006; 95(5): 622-3.

[52] Foster BJ, Bernard C, Drummond KN, Sharma AK. Effective therapy for severe He‐ noch-Schonlein purpura nephritis with prednisone and azathioprine: a clinical and

[53] Shin JI, Park JM, Shin YH, Kim JH, Lee JS, Kim PK, Jeong HJ. Can azathioprine and steroids alter the progression of severe Henoch-Schonlein nephritis in children? Pe‐

[54] Shin JI, Lee JS, Jeong HJ. Azathioprine and tubulointerstitial nephritis in HSP. The

[55] Muzaffar M, Taj A, Sethi N, Kaw D. Rapidly progressing glomerulonephritis secon‐ dary to Henoch-Schonlein purpura treated with mycophenolate mofetil: a case report with atypical etiology and presentation. American Journal of Therapeutics 2010; 17:

[56] Martin S, Cramer CH, Heikenen J, Gitomer JJ. Gastrointestinal symptoms of Henoch-Schonlein purpura treated with mycophenolate mofetil. Journal of Pediatric Gastro‐

[57] Dede F, Onec B, Ayli D, Gonul II, Onec K. Mycophenolate mofetil treatment of cres‐ centic Henoch-Schonlein nephritis with IgA depositions. Scandinavian Journal of Ur‐

[58] Nikibakhsh AA, Mahmoodzadeh H, Karamyyar M, Hejazi S, Noroozi M, Macooie AA, Gholizadeh A, Gholizadeh L. Treatment of Complicated Henoch-Schonlein Pur‐ pura with Mycophenolate Mofetil: A Retrospective Case Series Report. International

[59] Du Y, Hou L, Zhao C, Han M, Wu Y. Treatment of children with Henoch-Schonlein purpura nephritis with mycophenolate mofetil. Pediatric Nephrology (Berlin, Ger‐

[60] Donnithorne KJ, Atkinson TP, Hinze CH, Nogueira JB, Saeed SA, Askenazi DJ, Beu‐ kelman T, Cron RQ. Rituximab therapy for severe refractory chronic Henoch-Schon‐

[61] Pillebout E, Rocha F, Fardet L, Rybojad M, Verine J, Glotz D. Successful outcome us‐ ing rituximab as the only immunomodulation in Henoch-Schonlein purpura: case re‐

[62] Donghi D, Schanz U, Sahrbacher U, Recher M, Tr++eb RM, M++llhaupt B, French LE, Hafner J. Life-threatening or organ-impairing Henoch-Schonlein purpura: plasma‐ pheresis may save lives and limit organ damage. Dermatology (Basel, Switzerland)

[63] Wen YK, Yang Y, Chang CC. Cerebral vasculitis and intracerebral hemorrhage in He‐ noch-Sch+¦nlein purpura treated with plasmapheresis. Pediatric Nephrology (Berlin,

Journal of Rheumatology 2010; 2010 DOI:10.1155/2010/254316.

lein purpura. The Journal of Pediatrics 2009; 155: 136-9.

port. Nephrology, dialysis, transplantation 2011;26(6):2044-6.

histopathologic study. The Journal of Pediatrics 2000; 136: 370-5.

diatric Nephrology (Berlin, Germany) 2005; 20: 1087-92.

Journal of Rheumatology 2006; 33: 2551.

enterology and Nutrition 2006; 43: 245-7.

ology and Nephrology 2008; 42: 178-80.

many) 2012;27(5):765-71.

2009; 219(2): 167-70.

Germany) 2005; 20(2): 223-5.

e163-e166.

236 Updates in the Diagnosis and Treatment of Vasculitis


[76] Russell JP, Gibson LE. Primary cutaneous small vessel vasculitis: approach to diag‐ nosis and treatment. International Journal of Dermatology 2006; 45: 3-13.

**Chapter 10**

**Recent Advances in the Management of Refractory**

Systemic necrotizing vasculitides are a broad family of conditions characterized by injury or destruction of the blood vessel walls by inflammatory cells with subsequent vessel occlusion and ischemic tissue injury with high rates of morbidity and mortality. [1] The heterogeneous nature of the involved etio-pathogenetic mechanisms together with the diversities in clinical presentations poses a great challenge to successful induction and maintenance therapy in vasculitis.Untreated,thesediseasescanbedevastating.Treatmentstrategyinvasculitisdepends entirely upon the type of vasculitis, the pattern and severity of organ involvement. High dose corticosteroids and cytotoxic drugs remain the cornerstones in the management of vasculitis that dramatically improved the prognosis with increasing chances for remission. However, despite suchaggressive therapythe relapse rate insystemicvasculitis ranges from30-50%.With theincreasingrelapses insomecases,refractoriness tostandardcaremeasures inothers together with the toxicities associated with the use of long term high dose corticosteroids and cytotoxic

Thepathogeneticbackgroundinhumanautoimmunediseases remainspoorlyunderstood.The recent advances in the understanding of epigenetics of autoimmune rheumatic diseases have revealed a variety of disease specific pathways responsible for immune-mediated inflammato‐ ry and destructive events. In most of these situations including vasculitis the initial trigger is mostly an infectious trigger. It is mostly an antigen driven response that involves activation of the antigenpresentingcells (dendritic cells,macrophages,monocytes,Blymphocytes),priming of T lymphocytes towards a Th1, Th17 response. The primed Th1, Th17 lymphocytes initiates a cascade of pro-inflammatory events involving the release of pro-inflammatory cytokines (TNF alpha, IL-1 β,IL-6, TGF- β, IFN-γ, IL-17, IL-23) with subsequent priming of neutrophils, overexpression of adhesion molecules, activation of co-stimulatory signals with further release

> © 2013 Mohammed; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

drugs there is an increasing demand for an alternative effective therapy.

of pro-inflammatory mediators and autoantibody production. Figure 1

**Vasculitis**

Reem Hamdy A. Mohammed

http://dx.doi.org/10.5772/54517

**1. Introduction**

Additional information is available at the end of the chapter

