Etiología de las vasculitis cutáneas: utilidad de una aproximación sistémica

espanolLas vasculitis cutaneas (VC), primarias o como manifestacion de enfermedades sistemicas, constituyen un reto diagnostico. Objetivo: Determinar las causas de VC. Metodos: Se incluyeron pacientes con diagnostico de CV, a los cuales se les realizo valoracion clinica, biopsia cutanea y examenes de laboratorio. En la mayoria de los casos se realizo inmunofluorescencia directa. Los casos se clasificaron con los criterios del American College of Rheumatology (ACR) y la Chapel Hill Consensus Conference (CHCC). Resultados: Se incluyeron 32 pacientes; la frecuencia fue mayor en mujeres (71.8%). Los ninos presentaron VC asociadas a medicamentos o purpura de Schonlein-Henoch (PSH). En adultos se reporto con mas frecuencia PSH, vasculitis asociada a lupus eritematoso sistemico y vasculitis paraneoplasicas; otros diagnosticos etiologicos incluyeron poliarteritis nodosa (PAN), poliangeitis microscopica (PAM), vasculitis trombotica (pospuerperal), sindrome antifosfolipidos (SAF), sindrome de Churg-Strauss (SCS) y VC asociada a medicamentos. Utilizando los criterios del ACR y la CHCC para vasculitis se clasifico el 50% de los casos. Discusion: En el Hospital Gea, durante este trabajo, el diagnostico etiologico de las CV se incremento mas del doble. Sin embargo, en relacion a los diagnosticos vasculitis por hipersensibilidad (VHS) y PSH ninguna de las clasificaciones utilizadas contaba con criterios especificos. Seis pacientes permanecieron sin clasificar. Observamos que los estudios de crioglobulinas y serologia para hepatitis no son utiles como estudios iniciales, salvo que la historia clinica del paciente lo sugiera. Los pacientes sin clasificar se siguieron por dos anos. EnglishCutaneous vasculities (CV) represents a diagnostic challenge, occurs as primary cutaneous disorder or as a manifestation of other entities. Objective: To search the cause of CV. Methods: Patients with CV were prospectively evaluated. In all patients, skin biopsies were drawn, and direct immunofluorescence was done in most of the patients. American College of Rheumatology (ACR) and Chapel Hill Consensus Conference Criteria (CHCC) were used for classification. Results: 32 patients were studied. There was female predominance (71.8%). Children presented drug-associated CV or Schonlein-Henoch purpura (SHP). Adults presented more frequently SHP, systemic lupus erythematosus or paraneoplastic vasculitis, other diagnosis as polyarteritis nodosa, microscopic polyangiitis, thrombotic vasculitis (post-puerperal), antiphospholipid syndrome, Churg-Strauss syndrome, and drug-associated CV were presented. Using the ACR and CHCC criteria, 50% of cases were classified. Discussion: In our institution, during this work the etiologic diagnostic of CV increased more than twice. However, in the case of HSV or LA and SHP none of the proposed criteria had high specificity; other parameters were used to discern between both. Six patients remained as not classified. In our view, cryoglobulins and hepatitis serology do not seem useful unless patient’s history supports they need to be done. Unclassified patients were followed-up closely for 2 years.