Differentials
Small to medium vessel vasculitis
SIGNS / SYMPTOMS
No differentiating signs/symptoms.
INVESTIGATIONS
Vasculitis mimics, such as subacute endocarditis, need to be identified urgently. Vasculitis can be life-threatening, especially if there is significant multiple organ failure.
Because medium-vessel vasculitis may occur due to underlying viral infections, symptoms of mesenteric ischemia, evidence of cardiac decompensation, or hypertension should also be sought.
Blood cultures, echocardiogram, HIV test, antiphospholipid antibodies, lupus anticoagulant, and other infectious-disease workup suggested by the history (e.g., Rocky mountain spotted serologies) should be performed.
A CBC, comprehensive chemistry panel, and urinalysis should be carried out to measure the extent of vasculitis.[4]
Antinuclear antibodies and antineutrophil cytoplasmic antibodies, extractable nuclear antigen antibody, dsDNA, complement assay, eosinophil count, and specific biopsies (e.g., IgA deposits on skin or kidney suggesting Henoch-Schonlein purpura) should be ordered to establish etiology.
Cryofibrinogenemia
SIGNS / SYMPTOMS
Acute unexplained areas of tissue ischemia and gangrene; rare disorder.[42]
INVESTIGATIONS
Cryofibrinogenemia is a rare disorder that should be considered in any patient presenting with acute unexplained areas of tissue ischemia and gangrene.[42] Cryoglobulins and other causes of vaso-occlusive disease should be excluded.
Cryofibrinogens are detected by cold precipitation.
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