El Ouni Amira, Ben Messaoud Faiza, Khayati Rym, Abdelkafi C, Meddeb Zeineb, Hamzaoui Saloua, Larbi Thara, Toujani Sana, Bouslama Kamel
CHU Mongi Slim, La Marsa, Tunisia.
Mediterr J Rheumatol. 2024 Jan 29;35(1):94-107. doi: 10.31138/mjr.280723.aov. eCollection 2024 Mar.
Vascular purpura can be the clinical expression of infectious, inflammatory, drug-related, neoplastic, and endocrine pathologies. To date, there is no consensus codifying the investigation of vascular purpura, especially when it is isolated.
We proposed to study through a retrospective study of 73 cases of vascular purpura, occurring during the period 2004-2019 in our internal medicine department, the contribution of various clinical and paraclinical data to the aetiological diagnosis of vascular purpura. Data were considered to be contributory only when they constituted a solid argument in favour of the aetiological diagnosis of vascular purpura.
Our series involved 73 patients including 41 women and 32 men (Gender ratio: 0.78). Mean age was 49 ± 17 years [16-80]. Vascular purpura was isolated in 3% of cases. For the remaining patients, it was associated with functional (91%) or physical (48%) manifestations. It was associated with other skin lesions in 45% of cases. The accepted aetiologies were primary vasculitis (26%), drug-related (15%), infectious (11%) and secondary to connectivitis (10%). No cause was found in a third of cases. Clinical data alone made it possible to suggest the aetiology in more than half of cases. Special investigations were contributory in 46% of cases. The course was contributory in 18% of patients for drug-related and paraneoplastic causes.
vascular purpura's diverse clinical presentation presents diagnostic challenges. Aetiologies include vasculitis, drug reactions, infections, and connective tissue disorders. Comprehensive clinical assessment is essential.
血管性紫癜可能是感染性、炎症性、药物相关性、肿瘤性和内分泌性疾病的临床表现。迄今为止,对于血管性紫癜的检查尚无统一规范,尤其是孤立性血管性紫癜。
我们通过回顾性研究2004年至2019年期间在我们内科发生的73例血管性紫癜病例,探讨各种临床和辅助检查数据对血管性紫癜病因诊断的贡献。仅当这些数据构成支持血管性紫癜病因诊断的确凿依据时,才被视为有参考价值。
我们的系列研究纳入了73例患者,其中41例女性,32例男性(性别比:0.78)。平均年龄为49±17岁[16 - 80岁]。3%的病例为孤立性血管性紫癜。其余患者中,血管性紫癜与功能性(91%)或躯体性(48%)表现相关。45%的病例伴有其他皮肤损害。公认的病因包括原发性血管炎(26%)、药物相关性(15%)、感染性(11%)以及结缔组织病继发(10%)。三分之一的病例未发现病因。仅临床数据就能在半数以上病例中提示病因。特殊检查在46%的病例中有参考价值。病程对药物相关性和副肿瘤性病因的诊断有参考价值的占18%的患者。
血管性紫癜多样的临床表现带来了诊断挑战。病因包括血管炎、药物反应、感染和结缔组织病。全面的临床评估至关重要。