**9. Parasitic causes of vasculitis**

*Toxocara canis* presented in an adolescent as palpable purpura with additional features suggesting Henoch-Schönlein purpura [149]. *Cysticercus* has caused vasculitis and arachnoi‐ ditis as it infects the central nervous system [150] *Angiostrongylus* nematodes apparently caused a Wegener's granulomatosis-like pulmonary angiitis [151]. Loa loa, a filarial parasite, presented with cutaneous leukocytoclastic vasculitis

## **Author details**

immune response to occur. Viral replication increases HBsAg load, and is temporally associated with jaundice [32]. The immune complexes eventually no longer form in antigen excess, and the serum sickness-like illness resolves. HBV has also been associated with largevessel polyarteritis nodosa-like illness [33]. Onset is early in the course of chronic HBV

Immune complexes containing HBsAg, HBsAb, and complement are found in the vessel wall [34]. The determinants of small vessel versus larger vessel disease in the two syndromes of

Human immunodeficiency virus (HIV) patients may present with a variety of vasculitides. However, it is difficult to specifically attribute the various vasculitides seen to HIV because of frequent co-infections with other agents that may cause vasculitis in the absence of HIV

Human T lymphotropic virus l infection may cause retinal, cutaneous, or central nervous

The herpesviruses (cytomegalovirus, varicella-zoster, herpes simplex viruses 1 and 2, and herpes hominis) may be associated with retinal vasculitis in immunocompromised patients [39-45]. Varicella-zoster may also cause a diffuse central nervous system small arterial granulomatous vasculitis, or a small- and/or large-artery vasculopathy [46-48, 117]. Herpes simplex viruses 1 and 2 have been associated with cutaneous vasculitis and necrotizing arteritis of small and medium vessels [118-120]. Epstein-Barr virus has been suggested as a cause of both small- and large-vessel disease in a number of cases and short series [121-126]. However, the ability to demonstrate causality in many instances is made all the more difficult by the

Varicella zoster virus and CMV have been as well implicated in the etiopathogenesis of various vasculitides via numerous and overlapping mechanisms including direct microbial invasion of endothelial cells, immune complex mediated vessel wall damage and stimulation of

Vasculitis following varicella-herpes zoster infection occasionally develops in the form of a central neurological deficiency (locomotor deficiency with or without aphasia around one month after an ophthalmologic herpes zoster) or involving the retina or, more rarely, the skin or the kidneys. Vasculitis associated with cytomegaloviral infection,predominantly observed in immunodepressed patients, is diffuse and basically involving the digestive tube, notably

Parvovirus B19 has been suggested as the causative agent of Wegener's granulomatosis and polyarteritis nodosa in a number of cases and short series [128-133]. However, the issue of latency and the failure to eliminate B19 from pooled blood products provides a cautionary note when considering causality [134-137]. Rare cases of vasculitis have similarly been reported following rubella virus, adenovirus, echovirus, coxsackievirus, parainfluenza virus, herpes

autoreactive B and/or T cells through molecular mimicry and superantigens [71].

the colon, the central nervous system and the skin [127].

simplex viruses, and hepatitis A virus infections [23, 138-148].

hepatitis.

infection.

HBV infection are unknown.

148 Updates in the Diagnosis and Treatment of Vasculitis

system vasculitis [35-38].

latency of herpesvirus infection.

Jacques Choucair

Hotel Dieu de France hospital, Beirut, Lebanon

### **References**


[4] Coombs RRAGell PGH. The classification of allergic reactions underlying disease. In: Clinical aspects of immunology. Gell PGH, Coombs RRA, eds. Philadelphia: Davis, (1963).

[17] Stroemann, A, Künzel, K, Hiepe, S, Beier, W, Burmester, G. R, & Krause, A. Procalci‐ tonin: Marker for bactericidal infections in patients with rheumatic diseases. Z Rheu‐

Infectious Causes of Vasculitis http://dx.doi.org/10.5772/55189 151

[18] Moosig, F, & Csernok, E. Reinhold‐Keller E, Schmitt WH, Gross WL. Elevated procal‐ citonin levels in active Wegener's granulomatosis. J Rheumatol(1998). , 25, 1531-3.

[19] Brusch, J. L. Infective endocarditis and its mimics in the critical care unit. In: Cunha BA, ed. *Infectious Diseases in Critical Care*. 2nd ed. New York, NY: Informa Healthcare;

[20] Karchmer, A. W. Infective endocarditis. In: *Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine*. 7th ed. WB Saunders Co; (2005). , 2005, 1633-1658.

[21] Karchmer, A. W. Infective endocarditis. In: *Harrison's Principles of Internal Medicine*.

[22] Xiong, Y. Q, Fowler, V. G, Yeaman, M. R, Perdreau-remington, F, Kreiswirth, B. N, & Bayer, A. S. Phenotypic and genotypic characteristics of persistent methicillin-resist‐ ant Staphylococcus aureus bacteremia in vitro and in an experimental endocarditis

[23] Osler, W. Malignant endocarditis (Gulstonian Lecture I). *Lancet*. (1885). , 1, 415-418.

[24] Chan, F. Y, Crawford, E. S, Coselli, J. S, & Safi, H. J. Williams TW Jr. In situ prosthetic graft replacement for mycotic aneurysm of the aorta. *Ann Thorac Surg*. (1989). , 47(2),

[25] Bohmfalk, G. L, Story, J. L, & Wissinger, J. P. Brown WE Jr. Bacterial intracranial

[26] Jones HR JrSiekert RG. Neurological manifestations of infective endocarditis. Review

[27] Leo, P. J, Pearl, J, & Tsang, W. Mycotic aneurysm: a diagnostic challenge. *Am J Emerg*

[28] Cloft, H. J, Kallmes, D. F, Jensen, M. E, Lanzino, G, & Dion, J. E. Endovascular treat‐ ment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short

[29] Shaikholeslami, R, Tomlinson, C. W, Teoh, K. H, Molot, M. J, & Duke, R. J. Mycotic aneurysm complicating staphylococcal endocarditis. *Can J Cardiol*. (1999). , 15(2),

[30] Ziment, I. Nervous system complications in bacterial endocarditis. *Am J Med*. (1969). ,

[31] Walsh, D. W, Ho, V. B, & Haggerty, M. F. Mycotic aneurysm of the aorta: MRI and

MRA features. *J Magn Reson Imaging*. (1997). , 7(2), 312-315.

guglielmi detachable coils. *AJNR Am J Neuroradiol*. (1999). , 20(2), 308-310.

of clinical and therapeutic challenges. *Brain*. (1989). Pt 5):1295-1213.

matol(1996). suppl. 1):86.

(2007). , 2007, 261-2.

193-203.

217-222.

47(4), 593-607.

*Med*. (1996). , 14(1), 70-73.

16th ed. McGraw-Hill; (2005). , 2005, 731-40.

model. *J Infect Dis*. Jan 15 (2009). , 199(2), 201-8.

aneurysm. *J Neurosurg*. (1978). , 48(3), 369-382.


[17] Stroemann, A, Künzel, K, Hiepe, S, Beier, W, Burmester, G. R, & Krause, A. Procalci‐ tonin: Marker for bactericidal infections in patients with rheumatic diseases. Z Rheu‐ matol(1996). suppl. 1):86.

[4] Coombs RRAGell PGH. The classification of allergic reactions underlying disease. In: Clinical aspects of immunology. Gell PGH, Coombs RRA, eds. Philadelphia: Davis,

[5] Hagen, E. C, Daha, M. R, Hermans, J, et al. Diagnostic value of standardized assays for anti‐neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. Clin

[6] Rao, J. K, Allen, N. B, Feussner, J. R, & Weinberger, M. A prospective study of anti‐ neutrophil cytoplasmic antibody (cANCA) and clinical criteria in diagnosing Wege‐

[7] Rao, J. K, Weinberger, M, Oddone, E. Z, Allen, N. B, Lansman, P, & Feussner, J. R. The role of antineutrophil cytoplasmic antibody (cANCA) testing in the diagnosis of

[8] Hagen, E. C, Daha, M. R, Hermans, J, et al. Diagnostic value of standardized assays for anti‐neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. Clin

[9] Edgar JDMMcMillan SA, Bruce JN, Caulan SK. An audit of ANCA in routine clinical

[10] Csernok, W. L, & Immunodiagnostic, E. and pathophysiologic aspects of antineutro‐ phil cytoplasmic antibodies in vasculitis. Curr Opin Rheumatol(1995). , 7, 11-9.

[11] Zhao, M. H, Jones, S. J, & Lockwood, C. M. Bactericidal/permeability increasing pro‐ tein (BPI) is an important antigen for antineutrophil cytoplasmic autoantibodies

[12] Stoffel, M. P, Csernok, E, Herzberg, C, Johnston, T, Carroll, S. F, & Gross, W. L. Anti‐ neutrophil cytoplasmic antibodies (ANCA) directed against bactericidal/permeabili‐ ty increasing protein (BPI): A new seromarker for inflammatory bowel disease and

[13] Schultz H, Csernok E, Johnston TW, Lockwood CM, Gross WL. Use of native and re‐ combinant bactericidal/permeability increasing protein (BPI) as antigens for detec‐

[14] Lamprecht, P, Gadola, S, Schnabel, A, & Gross, W. L. ANCA, infectious endocarditis, glomerulonephritis and cryoglobulinemic vasculitis. Clin Nephrol(1998). letter).

[15] Schmitt, W. H, Csernok, E, Kobayashi, S, & Klinkenborg, A. Reinhold‐Keller E, Gross WL. Churg-Strauss Syndrome: Serum markers of lymphocyte activation and endo‐

[16] Schmitt, W. H, Heesen, C, Csernok, E, Rautmann, A, & Gross, W. L. Elevated serum levels of soluble interleukin‐2 receptor (sIL‐2R) in Wegener's granulomatosis (WG):

Association with disease activity. Arthritis Rheum(1992). , 35, 1088-96.

(1963).

Nephrol(1998). , 53, 743-53.

150 Updates in the Diagnosis and Treatment of Vasculitis

Nephrol(1998). , 53, 743-53.

ner's granulomatosis. Lancet(1995). , 346, 926-31.

practice. Postgrad Med J(1995). , 71, 605-12.

Wegener's granulomatosis. Ann Intern Med(1995). , 123, 925-32.

(ANCA) in vasculitides. Clin Exp Immunol(1995). , 99, 49-56.

associated disorders. Clin Exp Immunol(1996). , 104, 54-9.

tion of BPI‐ANCA. J Immunol Methods 1997;205:127-33.

thelial damage. Arthritis Rheum(1997). , 41, 445-52.


[32] Huston, J. rd, Nichols DA, Luetmer PH, et al. Blinded prospective evaluation of sen‐ sitivity of MR angiography to known intracranial aneurysms: importance of aneur‐ ysm size. *AJNR Am J Neuroradiol*. (1994). , 15(9), 1607-1614.

[45] Hoen, B, Briancon, S, Delahaye, F, et al. Tumors of the colon increase the risk of de‐ veloping *Streptococcus bovis* endocarditis: case-control study. *Clin Infect Dis*. (1994). ,

Infectious Causes of Vasculitis http://dx.doi.org/10.5772/55189 153

[46] Zarkin, B. A, Lillemoe, K. D, Cameron, J. L, Effron, P. N, Magnuson, T. H, & Pitt, H. A. The triad of *Streptococcus bovis* bacteremia, colonic pathology, and liver disease.

[47] Kupferwasser, I, Darius, H, Muller, A. M, et al. Clinical and morphological character‐ istics in *Streptococcus bovis* endocarditis: a comparison with other causative microor‐

[48] Friedrich, I. A, Wormser, G. P, & Gottfried, E. B. The association of remote *Streptococ‐ cus bovis* bacteremia with colonic neoplasia. *Am J Gastroenterol*. (1982). , 77(2), 82-84.

[49] Kodo, K, Hida, M, Omori, S, Mori, T, Tokumura, M, Kuramochi, S, et al. Vasculitis associated with septicemia: case report and review of the literature. Pediatr Nephrol

[50] Conti, T, & Barnet, B. The diagnostic challenge of infective endocarditis: cutaneous vasculitis leading to the diagnosis of infective endocarditis. J Am Board Fam Pract

[51] Mylonakis E CSBInfective endocarditis in adults. N Engl J Med (2001). Steitz A, Orth T, Feddersen A, Fischer T, Marker-Hermann E, Husmann M. A case of endocarditis with vasculitis due to *Actinobacillus actinomycetemcomitans:* a 16S rDNA signature for distinction from related organisms. Clin Infect Dis 1998; 27:224-225., 345(18),

[52] Steitz, A, Orth, T, Feddersen, A, Fischer, T, Marker-hermann, E, & Husmann, M. A case of endocarditis with vasculitis due to *Actinobacillus actinomycetemcomitans:* a 16S rDNA signature for distinction from related organisms. Clin Infect Dis (1998). , 27,

[53] Cohen, C. A, Almeder, L. M, Israni, A, & Maslow, J. N. *Clostridium septicum* endocar‐ ditis complicated by aortic-ring abscess and aortitis. Clin Infect Dis (1998). , 26,

[54] Elzouki, A. Y, Akthar, M, & Mirza, K. Brucella endocarditis associated with glomeru‐

[55] Bani-sadr, F, Hamidou, M, Richard, P, Tiab, M, Lalande, S, & Grolleau, J. Y. Cutane‐ ous vasculitis and acute renal failure disclosing endocarditis caused by *Actinobacillus*

[56] Gladstone, J. L, Friedman, S. A, Cerruti, M. M, & Jomain, S. L. Treatment of *Candida*

endocarditis and arteritis. J Thorac Cardiovasc Surg (1976). , 71, 835-838.

lonephritis and renal vasculitis. Pediatr Nephrol (1996). , 10, 748-751.

*actinomycetemcomitans*). Presse Med (1993).

19(2), 361-362.

*Ann Surg*. (1990). , 211(6), 786-791.

(2001). , 16, 1089-1092.

(2001). , 14, 451-456.

1318-1330.

224-225.

495-496.

ganisms in 177 cases. *Heart*. (1998). , 80(3), 276-280.


[45] Hoen, B, Briancon, S, Delahaye, F, et al. Tumors of the colon increase the risk of de‐ veloping *Streptococcus bovis* endocarditis: case-control study. *Clin Infect Dis*. (1994). , 19(2), 361-362.

[32] Huston, J. rd, Nichols DA, Luetmer PH, et al. Blinded prospective evaluation of sen‐ sitivity of MR angiography to known intracranial aneurysms: importance of aneur‐

[33] Schwartz, R. B, Tice, H. M, Hooten, S. M, Hsu, L, & Stieg, P. E. Evaluation of cerebral aneurysms with helical CT: correlation with conventional angiography and MR an‐

[34] Benjamin, M. E. Cohn EJ Jr, Purtill WA, Hanna DJ, Lilly MP, Flinn WR. Arterial re‐ construction with deep leg veins for the treatment of mycotic aneurysms. *J Vasc Surg*.

[35] Johnston, S. C, Wilson, C. B, Halbach, V. V, et al. Endovascular and surgical treat‐ ment of unruptured cerebral aneurysms: comparison of risks. *Ann Neurol*. (2000). ,

[36] Bederson, J. B, Awad, I. A, Wiebers, D. O, et al. Recommendations for the manage‐ ment of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association. *Stroke*.

[37] Johnston, S. C, Zhao, S, Dudley, R. A, Berman, M. F, & Gress, D. R. Treatment of un‐

[38] Brown, S. L, Busuttil, R. W, Baker, J. D, Machleder, H. I, Moore, W. S, & Barker, W. F. Bacteriologic and surgical determinants of survival in patients with mycotic aneur‐

[39] Brouwer, R. E, Van Bockel, J. H, & Van Dissel, J. T. *Streptococcus pneumoniae*, an emerging pathogen in mycotic aneurysms? *Neth J Med*. (1998). , 52(1), 16-21.

[40] Ballet, M, Gevigney, G, Gare, J. P, Delahaye, F, Etienne, J, & Delahaye, J. P. Infective endocarditis due to *Streptococcus bovis*. A report of 53 cases. *Eur Heart J*. (1995). ,

[41] Murray, H. W, & Roberts, R. B. *Streptococcus bovis* bacteremia and underlying gastro‐

[42] Selton-suty, C, Hoen, B, Delahaye, F, et al. Comparison of infective endocarditis in patients with and without previously recognized heart disease. *Am J Cardiol*. (1996). ,

[43] Cabell, C. H, Jollis, J. G, Peterson, G. E, et al. Changing patient characteristics and the effect on mortality in endocarditis. *Arch Intern Med*. (2002). , 162(1), 90-94.

[44] Roberts, R. B. Streptococcal endocarditis: the viridans and beta hemolytic streptococ‐ ci. In: Kaye D, ed. *Infective Endocarditis*. 2nd ed. New York: Raven Press; (1992).

intestinal disease. *Arch Intern Med*. (1978). , 138(7), 1097-1099.

ruptured cerebral aneurysms in California. *Stroke*. (2001). , 32(3), 597-605.

ysm size. *AJNR Am J Neuroradiol*. (1994). , 15(9), 1607-1614.

giography. *Radiology*. (1994). , 192(3), 717-722.

(1999). , 30(6), 1004-1015.

152 Updates in the Diagnosis and Treatment of Vasculitis

(2000). , 31(11), 2742-2750.

16(12), 1975-1980.

77(12), 1134-1137.

ysms. *J Vasc Surg*. (1984). , 1(4), 541-547.

48(1), 11-19.


[57] Martinez, A. J, Sotelo-avila, C, Alcala, H, & Willaert, E. Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba. Acta Neuro‐ pathol (Berl) (1980). , 49, 7-12.

[73] Henocq, E, Hutinel, B, Jacob, J, & Olivier, C. Immunopathologic aspects of recurrent phlebitis and nodular vascularitis. Therapeutic applications). Phlebologie (1976). , 29,

Infectious Causes of Vasculitis http://dx.doi.org/10.5772/55189 155

[74] Strnad, B. T, Mcgraw, J. K, Heatwole, E. V, & Clark, P. Tuberculous aneurysm of the aorta presenting with uncontrolled hypertension. J Vasc Interv Radiol (2001). , 12,

[75] Allins, A. D, Wagner, W. H, Cossman, D. V, Gold, R. N, & Hiatt, J. R. Tuberculous infection of the descending thoracic and abdominal aorta: case report and literature

[76] Tuder, R. M, Renya, G. S, & Bensch, K. Mycobacterial coronary arteritis in a heart

[77] Nenoff, P, Kellermann, S, Horn, L. C, Keiner, S, Bootz, F, & Schneider, S. al. Case re‐ port. Mycotic arteritis due to *Aspergillus fumigatus* in a diabetic with retrobulbar as‐

[78] Oaks, T. E, Pae, W. E, Pennock, J. L, Myers, J. L, & Pierce, W. S. Aortic rupture caused by fungal aortitis: successful management after heart transplantation. J Heart Trans‐

[79] De Carvalho, C. A, Allen, J. N, Zafranis, A, & Yates, A. J. Coccidioidal meningitis complicated by cerebral arteritis and infarction. Hum Pathol (1980). , 11, 293-296. [80] Kobayashi, R. M, Coel, M, Niwayama, G, & Trauner, D. Cerebral vasculitis in cocci‐

[81] Whitaker, D. C, & Lynch, P. J. Erythema nodosum and coccidioidomycosis. Ariz Med

[82] Body, B. A. Cutaneous manifestations of systemic mycoses. Dermatol Clin (1996). ,

[83] Mastrolonardo, M, Loconsole, F, Conte, A, & Rantuccio, F. Cutaneous vasculitis as the sole manifestation of disseminated gonococcal infection: case report. Genitourin

[84] Garcia-patos, V, Barnadas, M. A, Domingo, P, Esquius, J, & De Moragas, J. M. Cuta‐ neous vasculitis during bacteremia caused by meningococcus serogroup B). Rev Clin

[85] Dearaujomartins-romeo, D, Garcia-porrua, C, & Gonzalez-gay, M. A. Cutaneous vas‐

[86] Seaton, R. A, Nathwani, D, Dick, J, & Smith, D. Acute meningococcaemia complicat‐

ed by late onset gastrointestinal vasculitis. J Infect (2000). , 41, 190-191.

review. Ann Vasc Surg (1999). , 13, 439-444.

plant (1988). , 7, 162-164.

(1979). , 36, 887-889.

Med (1994). , 70, 130-131.

Esp (1992). , 190, 311-313.

14, 125-135.

transplant recipient. Hum Pathol (1986). , 17, 1072-1074.

dioidal meningitis. Ann Neurol (1977). , 1, 281-284.

culitis is not always benign. Rev Rhum Engl Ed (1999).

pergillosis and mycotic meningitis. Mycoses (2001). , 44, 407-414.

125-132.

521-523.


[73] Henocq, E, Hutinel, B, Jacob, J, & Olivier, C. Immunopathologic aspects of recurrent phlebitis and nodular vascularitis. Therapeutic applications). Phlebologie (1976). , 29, 125-132.

[57] Martinez, A. J, Sotelo-avila, C, Alcala, H, & Willaert, E. Granulomatous encephalitis, intracranial arteritis, and mycotic aneurysm due to a free-living ameba. Acta Neuro‐

[58] Vyas, S. K, Law, N. W, & Loehry, C. A. Mycotic aneurysm of left subclavian artery.

[60] Julke, M, & Leu, H. J. Extra-aortic aneurysms. Analysis of 163 aneurysms in 142 pa‐

[61] La Civita LFadda P, Olivieri I, Ferri C. Cryoglobulinaemic vasculitis as presenting manifestation of infective endocarditis. Ann Rheum Dis (2002). , 61, 89-90.

[62] Yerly, P, Chuard, C, Pugin, P, & Regamey, C. Cryoglobulins and endocarditis, a case

[63] Agarwal, A, Clements, J, Sedmak, D. D, & Imler, D. Nahman NS Jr, Orsinelli DA, et al. Subacute bacterial endocarditis masquerading as type III essential mixed cryoglo‐

[64] Lum, P. N, Woo, P. C, Wong, S. S, & Yuen, K. Leukocytoclastic vasculitis complicat‐ ing *Klebsiella pneumoniae* bacteremia. Diagn Microbiol Infect Dis (2000). , 37, 275-277.

[65] Garcia-porrua, C, & Gonzalez-gay, M. A. Bacterial infection presenting as cutaneous

[66] Houston, T. P. Small-vessel vasculitis following simultaneous influenza and pneu‐

[67] David, J, Ansell, B. M, & Woo, P. Polyarteritis nodosa associated with streptococcus.

[68] Walker, D. H, Cain, B. G, & Olmstead, P. M. Laboratory diagnosis of Rocky Moun‐ tain spotted fever by immunofluorescent demonstration of Rickettsia in cutaneous le‐

[69] George, F, Brouqui, P, Boffa, M. C, Mutin, M, Drancourt, M, Brisson, C, et al. Demon‐ stration of *Rickettsia conorii*-induced endothelial injury in vivo by measuring circulat‐ ing endothelial cells, thrombomodulin, and von Willebrand factor in patients with

[70] Davi, G, Giammarresi, C, Vigneri, S, Ganci, A, & Ferri, C. Di Francesco L, et al. Dem‐ onstration of *Rickettsia conorii*-induced coagulative and platelet activation in vivo in patients with Mediterranean spotted fever. Thromb Haemost (1995). , 74, 631-634.

[72] Reich, J. M. Pulmonary gangrene and the air crescent sign. Thorax (1993). , 48, 70-74.

[59] Jenckes GA IIIAspergillus aortitis. J Thorac Cardiovasc Surg (1990). , 99, 375-376.

tients). Schweiz Med Wochenschr (1985). , 115, 10-13.

report.) Rev Med Suisse Romande (2001). , 121, 573-576.

vasculitis in adults. Clin Exp Rheumatol (1999). , 17, 471-473.

mococcal vaccination. N Y State J Med (1983). , 83, 1182-1183.

Mediterranean spotted fever. Blood (1993). , 82, 2109-2116.

bulinemia. J Am Soc Nephrol (1997). , 8, 1971-1976.

Arch Dis Child (1993). , 69, 685-688.

sions. Am J Clin Pathol (1978). , 69, 619-623.

[71] Clin Dev Immunol(2004). Sep-Dec;11(3-4):227-31

pathol (Berl) (1980). , 49, 7-12.

154 Updates in the Diagnosis and Treatment of Vasculitis

Br Heart J (1993). , 69, 455-456.


[87] Versapuech, J, Leaute-labreze, C, Thedenat, B, Taieb, A, & Ragnaud, J. M. Ecthyma gangrenosum caused by *Pseudomonas aeruginosa* without septicemia in a neutropenic patient). Rev Med Interne (2001). , 22, 877-880.

[101] Aizawa, H, Hasegawa, A, Arai, M, Naganuma, F, Hatori, M, Kanda, T, et al. Bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis. Intern Med

Infectious Causes of Vasculitis http://dx.doi.org/10.5772/55189 157

[102] Samson, L, Chalaoui, J, & Paradis, B. Case of the day. General. Syphilitic aortitis, with saccular aneurysm of the descending aorta and fusiform aneurysm of the as‐

[103] Oksi, J, Kalimo, H, Marttila, R. J, Marjamaki, M, Sonninen, P, Nikoskelainen, J, et al. Intracranial aneurysms in three patients with disseminated Lyme borreliosis: cause

[104] Keil, R, Baron, R, Kaiser, R, & Deuschl, G. Vasculitis course of neuroborreliosis with

[105] Oksi, J, Kalimo, H, Marttila, R. J, Marjamaki, M, Sonninen, P, Nikoskelainen, J, et al. Inflammatory brain changes in Lyme borreliosis. A report on three patients and re‐

[106] Leys, A. M, Schonherr, U, Lang, G. E, Naumann, G. O, Goubau, P, Honore, A, et al. Retinal vasculitis in Lyme borreliosis. Bull Soc Belge Ophtalmol (1995). , 259, 205-214.

[107] Giang, D. W. Central nervous system vasculitis secondary to infections, toxins, and

[108] Smith, J. L, Winward, K. E, Nicholson, D. F, & Albert, D. W. Retinal vasculitis in

[109] Lang, G. E, Schonherr, U, & Naumann, G. O. Retinal vasculitis with proliferative ret‐ inopathy in a patient with evidence of *Borrelia burgdorferi* infection. Am J Ophthalmol

[110] Pizzarello, L. D. MacDonald AB, Semlear R, DiLeo F, Berger B. Temporal arteritis as‐ sociated with *Borrelia* infection. A case report. J Clin Neuroophthalmol (1989). , 9, 3-6.

[111] Lock, G, Berger, G, & Grobe, H. Neuroborreliosis: progressive encephalomyelitis with cerebral vasculitis). Monatsschr Kinderheilkd (1989). , 137, 101-104.

[112] Veenendaal-hilbers, J. A, Perquin, W. V, Hoogland, P. H, & Doornbos, L. Basal me‐ ningovasculitis and occlusion of the basilar artery in two cases of *Borrelia burgdorferi*

[113] Meier, C, & Grehl, H. Vasculitic neuropathy in the Garin-Bujadoux- Bannwarth syn‐ drome. A contribution to the understanding of the pathology and pathogenesis of the neurological complications in Lyme borreliosis). Dtsch Med Wochenschr (1988). ,

[114] Uldry, P. A, Regli, F, & Bogousslavsky, J. Cerebral angiopathy and recurrent strokes following *Borrelia burgdorferi* infection. J Neurol Neurosurg Psychiatry (1987). , 50,

or chance association? J Neurol Neurosurg Psychiatry (1998). , 64, 636-642.

cending aorta. Radiographics (1990). , 10, 508-510.

thalamic infarct). Nervenarzt (1997). , 68, 339-341.

view of literature. Brain (1996). , 119, 2143-2154.

neoplasms. Semin Neurol (1994). , 14, 313-319.

infection. Neurology (1988). , 38, 1317-1319.

(1991). , 111, 243-244.

113, 135-138.

1703-1704.

Lyme borreliosis. J Clin Neuroophthalmol (1991). , 11, 7-15.

(1998). , 37, 56-59.


[101] Aizawa, H, Hasegawa, A, Arai, M, Naganuma, F, Hatori, M, Kanda, T, et al. Bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis. Intern Med (1998). , 37, 56-59.

[87] Versapuech, J, Leaute-labreze, C, Thedenat, B, Taieb, A, & Ragnaud, J. M. Ecthyma gangrenosum caused by *Pseudomonas aeruginosa* without septicemia in a neutropenic

[88] Bonduel, M, Santos, P, Turienzo, C. F, Chantada, G, & Paganini, H. Atypical skin le‐ sions caused by *Curvularia* sp. and *Pseudallescheria boydii* in two patients after alloge‐ neic bone marrow transplantation. Bone Marrow Transplant (2001). , 27, 1311-1313.

[89] Mull, C. C, Scarfone, R. J, & Conway, D. Ecthyma gangrenosum as a manifestation of *Pseudomonas* sepsis in a previously healthy child. Ann Emerg Med (2000). , 36,

[90] Wu, B. Y, Peng, C. T, Tsai, C. H, & Chiu, H. H. Community-acquired *Pseudomonas aeruginosa* bacteremia and sepsis in previously healthy infants. Acta Paediatr Taiwan

[91] Fergie, J. E, Huang, D. B, Purcell, K, & Milligan, T. Successful treatment of *Fusarium solanae* ecthyma gangrenosum in a child with acute lymphoblastic leukemia in re‐

[92] Del Pozo JGarcia-Silva J, Almagro M, Martinez W, Nicolas R, Fonseca E. Ecthyma gangrenosum-like eruption associated with *Morganella morganii* infection. Br J Der‐

[93] Burgner, D, Eagles, G, Burgess, M, Procopis, P, Rogers, M, Muir, D, et al. Disseminat‐ ed invasive infection due to *Metarrhizium anisopliae* in an immunocompromised

[94] Repiso, T, Garcia-patos, V, Martin, N, Creus, M, Bastida, P, & Castells, A. Dissemi‐

[95] Martino, P, Gastaldi, R, Raccah, R, & Girmenia, C. Clinical patterns of *Fusarium* infec‐

[96] Jang, T. N, Wang, F. D, Wang, L. S, Liu, C. Y, & Liu, I. M. *Xanthomonas maltophilia* bacteremia: an analysis of 32 cases. J Formos Med Assoc (1992). , 91, 1170-1176. [97] Stotka, J. L, & Rupp, M. E. *Klebsiella pneumoniae* urinary tract infection complicated by endophthalmitis, perinephric abscess, and ecthyma gangrenosum. South Med J

[98] Edelstein, H, & Cutting, H. O. *Escherichia coli* as cause of ecthyma gangrenosum.

[99] Harris, R. L, Fainstein, V, Elting, L, Hopfer, R. L, & Bodey, G. P. Bacteremia caused by *Aeromonas* species in hospitalized cancer patients. Rev Infect Dis (1985). , 7,

[100] Cheng, T. O. Syphilitic aortitis is dying but not dead. Catheter Cardiovasc Interv

tions in immunocompromised patients. J Infect Dis (1994). Suppl 1):7-15.

patient). Rev Med Interne (2001). , 22, 877-880.

lapse. Pediatr Infect Dis J (2000). , 19, 579-581.

child. J Clin Microbiol (1998). , 36, 1146-1150.

nated fusariosis. Pediatr Dermatol (1996). , 13, 118-121.

383-387.

(1999). , 40, 233-236.

156 Updates in the Diagnosis and Treatment of Vasculitis

matol (1998). , 139, 520-521.

(1991). , 84, 790-793.

(2001). , 52, 240-241.

314-320.

Postgrad Med (1986). , 79, 44-45.


[115] MacDonald ABGiant cell arteritis and *Borrelia* infection. J Clin Neuroophthalmol (1987). , 7, 180-181.

[128] Naides, S. J. Rheumatic manifestations of parvovirus B19 infection. Rheum Dis Clin

Infectious Causes of Vasculitis http://dx.doi.org/10.5772/55189 159

[129] Aygoren-pursun, E, & Scharrer, I. A multicenter pharmacosurveillance study for the evaluation of the efficacy and safety of recombinant factor VIII in the treatment of pa‐ tients with hemophilia A. German Kogenate Study Group. Thromb Haemost (1997). ,

[130] Corman, L. C, & Dolson, D. J. Polyarteritis nodosa and parvovirus B19 infection. Lan‐

[131] Delannoy, D, Balquet, M. H, & Savinel, P. Vasculitis with mixed cryoglobulin in a

[132] Finkel, T. H, Torok, T. J, Ferguson, P. J, Durigon, E. L, Zaki, S. R, et al. Chronic parvo‐ virus B19 infection and systemic necrotizing vasculitis: opportunistic infection or ae‐

[133] Martinelli, C, Azzi, A, Buffini, G, Comin, C. E, & Leoncini, F. Cutaneous vasculitis due to human parvovirus B19 in an HIV-infected patient: report of a case. AIDS

[134] Erdman, D. D, Anderson, B. C, Torok, T. J, Finkel, T. H, & Anderson, L. J. Possible transmission of parvovirus B19 from intravenous immune globulin. J Med Virol

[135] Prowse, C, Ludlam, C. A, & Yap, P. L. Human parvovirus B19 and blood products.

[136] Yee, T. T, Cohen, B. J, Pasi, K. J, & Lee, C. A. Transmission of symptomatic parvovi‐ rus B19 infection by clotting factor concentrate. Br J Haematol (1996). , 93, 457-459.

[137] Flunker, G, Peters, A, Wiersbitzky, S, Modrow, S, & Seidel, W. Persistent parvovirus B19 infections in immunocompromised children. Med Microbiol Immunol (1998). ,

[138] Inman, R. D, Hodge, M, Johnston, M. E, Wright, J, & Heathcote, J. Arthritis, vasculi‐ tis, and cryoglobulinemia associated with relapsing hepatitis A virus infection. Ann

[139] Press, J, Maslovitz, S, & Avinoach, I. Cutaneous necrotizing vasculitis associated with

[140] Costa, M. M, Lisboa, M, Romeu, J. C, Caldeira, J, & De Q, V. Henoch-Schönlein pur‐ pura associated with coxsackie-virus B1 infection. Clin Rheumatol (1995). , 14,

[141] Okano, M, Thiele, G. M, Sakiyama, Y, Matsumoto, S, & Purtilo, D. T. Adenovirus in‐ fection in patients with Kawasaki disease. J Med Virol (1990). , 32, 53-57.

hepatitis A virus infection. J Rheumatol (1997). , 24, 965-967.

case of human parvovirus B19 infection. Presse Med (1993).

tiological agent? Lancet (1994). , 343, 1255-1258.

North Am (1998). , 24, 375-401.

78, 1352-1356.

(1997). , 11, 1891-1893.

(1997). , 53, 233-236.

186, 189-194.

488-490.

Vox Sang (1997). , 72, 1-10.

Intern Med (1986). , 105, 700-703.

cet (1992).


[128] Naides, S. J. Rheumatic manifestations of parvovirus B19 infection. Rheum Dis Clin North Am (1998). , 24, 375-401.

[115] MacDonald ABGiant cell arteritis and *Borrelia* infection. J Clin Neuroophthalmol

[116] Camponovo, F, & Meier, C. Neuropathy of vasculitic origin in a case of Garin-Bouja‐ doux-Bannwarth syndrome with positive *Borrelia* antibody response. J Neurol

[117] Caruso, J. M, Tung, G. A, & Brown, W. D. Central nervous system and renal vasculi‐ tis associated with primary varicella infection in a child. Pediatrics (2001). E9.

[118] Koo, E. H, & Massey, E. W. Granulomatous angiitis of the central nervous system: protean manifestations and response to treatment. J Neurol Neurosurg Psychiatry

[119] Schmitt, J. A, Dietzmann, K, Muller, U, & Krause, P. Granulomatous vasculitis-an un‐ common manifestation of herpes simplex infection of the central nervous system).

[120] Shiozi, Y, Takeshima, M, Itoshima, T, Nose, S, & Hamaya, K. Granulomatous angiitis of the central nervous system complicated by the syndrome of inappropriate antidiu‐

[121] Ban, S, Goto, Y, Kamada, K, Takahama, M, Watanabe, H, Iwahori, T, et al. Systemic granulomatous arteritis associated with Epstein-Barr virus infection. Virchows Arch

[122] Lande, M. B, Mowry, J. A, & Houghton, D. C. White CR Jr, Borzy MS. Immune com‐ plex disease associated with Epstein-Barr virus infectious mononucleosis. Pediatr

[123] Murakami, K, Ohsawa, M, Hu, S. X, Kanno, H, Aozasa, K, & Nose, M. Large-vessel arteritis associated with chronic active Epstein-Barr virus infection. Arthritis Rheum

[124] Nakagawa, A, Ito, M, Iwaki, T, Yatabe, Y, Asai, J, & Hayashi, K. Chronic active Ep‐ stein-Barr virus infection with giant coronary aneurysms. Am J Clin Pathol (1996). ,

[125] Muso, E, Fujiwara, H, Yoshida, H, Hosokawa, R, Yashiro, M, Hongo, Y, et al. Ep‐ stein-Barr virus genome-positive tubulointerstitial nephritis associated with Kawasa‐

[126] Kikuta, H, Sakiyama, Y, Matsumoto, S, Hamada, I, Yazaki, M, Iwaki, T, et al. Detec‐ tion of Epstein-Barr virus DNA in cardiac and aortic tissues from chronic, active Ep‐ stein-Barr virus infection associated with Kawasaki disease-like coronary artery

ki disease-like coronary aneurysms. Clin Nephrol (1993). , 40, 7-15.

[127] Cohen, P, & Guillevin, L. Presse Med. (2004). Nov 6;33(19 Pt 2):1371-84.

(1987). , 7, 180-181.

158 Updates in the Diagnosis and Treatment of Vasculitis

(1986). , 233, 69-72.

(1988). , 51, 1126-1133.

(1999). , 434, 249-254.

(1998). , 41, 369-373.

105, 733-736.

Nephrol (1998). , 12, 651-653.

aneurysms. J Pediatr (1993). , 123, 90-92.

Zentralbl Pathol (1992). , 138, 298-302.

retic hormone). No To Shinkei (1995). , 47, 595-599.


[142] Embil, J. A, Mcfarlane, E. S, Murphy, D. M, Krause, V. W, & Stewart, H. B. Adenovi‐ rus type 2 isolated from a patient with fatal Kawasaki disease. Can Med Assoc J (1985).

**Chapter 7**

**Vasculitis and Vasculopathy in Rheumatic Diseases**

Vessels and the vascular endothelium are involved in the pathogenesis of inflammatory rheumatic diseases a family of related disorders that include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). In these conditions vascular involvement is very important. This chapter aims to give an overview of the prevalence of the different forms of vasculopathy/vasculitis that can be encountered in the RA, SLE and SSc patients, describe their pathogenesis, and address their impact on disease severity and

SSc is a connective tissue disease characterized by fibrosis and vasculopathy involving multiple organ systems. Many clinical complications of SSc are due to dysfunction of vascular beds throughout the body. Involvement of the microvasculature leads to cutaneous and mucosal telangiectasias, digital ulcers, and tissue ischemia. If medium-sized blood vessels are involved, manifestations include gangrene, digital loss, renal crisis, and pulmonary arterial hypertension. While occlusive vasculopathy is a well-recognized feature of SSc, less is known about the occurrence and the consequences of frank vascular inflammation. Albeit rare, typical vasculitis with inflammatory infiltrates damaging blood vessels has been reported in patients with systemic sclerosis. The distinction between SSc vasculopathy and SSc-associated vascu‐ litis can be difficult to make based on clinical presentation alone, but knowledge of the underlying pathogenesis and histopathology can be very helpful. In the current pathogenic model of SSc, a vascular injury of unknown cause leads to endothelial apoptosis and initiates the process of SSc vasculopathy. Continuous endothelial dysfunction likely contributes to activation of adventitial fibroblasts with resultant intimal proliferation, eventual luminal narrowing, and tissue hypoxia. Histopathology of SSc vasculopathy reflects the underlying pathogenesis, with myofibroblast proliferation and matrix deposit in the subendothelial layer leading to obliterative thickening of vessel walls. Inflammatory infiltrates are absent, and the internal elastic lamina remains intact. In contrast to vasculopathy, concurrent vasculitis in SSc

> © 2013 Radić and Radić; 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, 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.

© 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,

outcome. All of these rheumatic diseases involve some level of underlying vasculitis.

Mislav Radić and Josipa Radić

http://dx.doi.org/10.5772/55056

**1. Introduction**

Additional information is available at the end of the chapter

