Jois Ramesh, Bajaj Radhika
Department of Clinical Immunology and Rheumatology, Manipal Hospital, Millers Road, Bangalore, India.
Best Pract Res Clin Rheumatol. 2025 May;39(2):102056. doi: 10.1016/j.berh.2025.102056. Epub 2025 Mar 14.
Infections can mimic Primary Systemic Vasculitis. Many clinical features and investigations maybe very similar between the two conditions. It is very important for the clinician to be aware of the various infections which mimic vasculitis, since inadvertent immunosuppression in these patients can be fatal. Infections can mimic small, medium or large vessel vasculitis. Infections can produce autoantibodies such as Anti-neutrophil cytoplasmic antibody through molecular mimicry and could confound clinical judgement. In addition to the many infections causing vasculitis, more recently COVID-19 associated vasculitis has been described. The exact pathogenesis of infection associated vasculitis is not clear although direct spread, immune complex deposition and T/B cell activation are proposed. Infection as an etiological agent for primary systemic vasculitis has long been debated but definite evidence for the same is lacking. Many drugs used in daily clinical practice can rarely cause vasculitis. More recently Immune-check point inhibitors-induced vasculitis has been described.
感染可酷似原发性系统性血管炎。两种情况之间的许多临床特征和检查可能非常相似。临床医生了解各种酷似血管炎的感染非常重要,因为这些患者不经意的免疫抑制可能是致命的。感染可酷似小、中或大血管血管炎。感染可通过分子模拟产生自身抗体,如抗中性粒细胞胞浆抗体,可能混淆临床判断。除了许多导致血管炎的感染外,最近还描述了与 COVID-19 相关的血管炎。尽管有人提出了直接传播、免疫复合物沉积和 T/B 细胞激活,但感染相关血管炎的确切发病机制尚不清楚。感染作为原发性系统性血管炎的病因长期以来一直存在争议,但缺乏确凿证据。日常临床实践中使用的许多药物很少会引起血管炎。最近还描述了免疫检查点抑制剂诱导的血管炎。