Vasculitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M.Umer Tariq [2] Jesus Rosario Hernandez, M.D. [3] Kiran Singh, M.D. [4]

• Elevated body temperature may be present (fever)

• Tachycardia may be present

• Decreased pulsation of one or both brachial arteries – Takayasu arteritis
• Decreased pulsations in the temporal artery – Temporal arteritis

• At least 10 mmHg systolic difference in both arms – in Takayasu arteritis
• New onset diastolic blood pressure > 90 mmHg – Polyarteritis nodosa

• Palpable purpura – if patients have this in isolation, it is most likely due to cutaneous leukocytoclastic vasculitis. If the purpura is in combination with systemic organ involvement, it is most likely to be Henoch-Schonlein purpura or microscopic polyarteritis.
• Livedo reticularis – Polyarteritis nodosa
• Erythema of palms/soles, edema of hands/feet, periungual desquamation, polymorphous rash – Kawasaki disease
• Palpable purpura, maculopapular rash – Hypersensitivity vasculitis

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

Images of vasculitis after Streptococcal throat infection

• Bilateral conjunctival injection – Kawasaki disease

• Tenderness on the sides of the head – Temporal arteritis
• Tenderness on the head may be present in Takayasu arteritis
• Nasal or oral inflammation (oral ulcers or purulent/bloody nasal discharge, may be painful) – Wegener’s granulomatosis
• Cervical lymphadenopathy (at least one node > 1.5 cm), injected or fissured lips, injected pharynx, or strawberry tongue – Kawasaki disease

• Bruit over one or both carotid arteries or abdominal aorta – Takayasu arteritis

• Claudication

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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]
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  .Allergicvasculitis Adapted from Dermatology Atlas.^[1]

• Mononeuropathy or polyneuropathy – Polyarteritis nodosa, Churg-Strauss arteritis

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