From the Guidelines
Vasculitis caused by infection should be treated with a dual approach that includes antimicrobial therapy to address the underlying infection and anti-inflammatory medications to control vessel damage, as evidenced by the most recent study 1. The pathogenesis of vasculitis caused by infection involves either direct microbial invasion of vessel walls or immune complex deposition from persistent infections.
- Direct microbial invasion can occur with pathogens such as syphilis or tuberculosis, where the microorganism directly infects the blood vessel walls.
- Immune complex deposition is seen in infections like hepatitis B or C, where the immune response to the infection leads to the formation of immune complexes that deposit in vessel walls, causing damage. Treatment requires addressing both the underlying infection and the inflammatory response.
- Antimicrobial therapy targeting the specific pathogen is essential, which may include antibiotics for bacterial infections, antivirals for viral causes, or antifungals for fungal etiologies.
- Anti-inflammatory medications may be needed to control vessel damage, ranging from NSAIDs for mild cases to corticosteroids for more severe inflammation. In severe cases with organ dysfunction, immunosuppressants like cyclophosphamide or rituximab might be required alongside antimicrobials, as suggested by recent guidelines 1. The treatment duration varies based on the pathogen and severity, typically continuing antimicrobials until infection resolution and tapering anti-inflammatories over weeks to months as inflammation subsides. Regular monitoring of inflammatory markers, organ function, and pathogen clearance is crucial to guide therapy adjustments, as recommended by recent studies 1. This dual approach works because eliminating the infectious trigger removes the stimulus for ongoing inflammation while anti-inflammatory medications prevent further vessel damage during pathogen clearance. Key considerations in management include:
- Accurate diagnosis and assessment of disease severity
- Differentiation between active vasculitis, infection, and other complications or comorbidities
- Access to multidisciplinary diagnostic evaluation and treatment, particularly in specialized vasculitis centers 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pathogenesis of Vasculitis Caused by Infection
- Vasculitis can be caused by various infectious agents, including bacteria, viruses, and parasites, which can lead to inflammation of the blood vessel walls through different mechanisms, such as direct microbial invasion of endothelial cells, immune complex-mediated vessel wall damage, and stimulation of autoreactive B and/or T cells through molecular mimicry and superantigens 2.
- The infectious agents implicated in the pathogenesis of vasculitis include hepatitis B virus, hepatitis C virus, human immunodeficiency virus, parvovirus B19, cytomegalovirus, varicella zoster virus, Staphylococcus aureus, rickettsiaceae, Treponema pallidum, and Borrelia burgdorferi, among others 2.
- The clinical features of vasculitis caused by infection can be nonspecific, and a high index of suspicion is required to make a diagnosis, which should be confirmed by appropriate cultures and serologic assays 3.
Treatment of Vasculitis Caused by Infection
- Early and aggressive treatment should be instituted if an infectious agent is confirmed to be the cause of vasculitis, and surgical intervention may be necessary to treat the associated anatomic and physiologic sequelae 3.
- In some cases, treatment with corticosteroids may be needed to prevent complications, especially in severe cases of leucocytoclastic vasculitis 4.
- Combination immunosuppressive therapy, including rituximab, low-dose cyclophosphamide, and plasma exchange, may be effective in treating severe antineutrophil cytoplasmic antibody-associated vasculitis, with a high rate of disease remission and low rates of relapse 5.