Differential Diagnosis for Vasculitis in the Neck in a Teenager
- Single most likely diagnosis
- Kawasaki disease: This is a leading cause of vasculitis in children and teenagers, characterized by inflammation in the walls of medium-sized arteries throughout the body, including those in the neck. It often presents with fever, rash, swelling of the hands and feet, irritation and redness of the eyes, lips, throat, and tongue.
- Other Likely diagnoses
- Henoch-Schönlein purpura (HSP): A form of vasculitis that affects blood vessels and is common in children and teenagers. It typically presents with palpable purpura, abdominal pain, and arthritis, but can also involve the neck.
- Giant Cell Arteritis (GCA): Although more common in older adults, GCA can occasionally occur in teenagers, causing inflammation of the arteries in the neck and scalp, leading to symptoms like headache, jaw claudication, and visual disturbances.
- Takayasu arteritis: A large vessel vasculitis that predominantly affects the aorta and its major branches, including those in the neck. It's more common in young women and can present with symptoms like arm claudication, reduced pulses, and hypertension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Infectious causes (e.g., bacterial, fungal, or viral infections): Certain infections can cause vasculitis as a complication, and missing these could lead to severe consequences, including sepsis or death. Examples include syphilis, tuberculosis, and fungal infections like aspergillosis.
- ANCA-associated vasculitis (e.g., Granulomatosis with Polyangiitis, formerly known as Wegener's granulomatosis): These conditions can present with a wide range of symptoms, including vasculitis in the neck, and are associated with anti-neutrophil cytoplasmic antibodies (ANCA). They can be life-threatening if not promptly treated.
- Lupus: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can cause vasculitis among its myriad manifestations. It's crucial to consider SLE, especially in female teenagers, due to its potential for serious complications.
- Rare diagnoses
- Behçet's disease: A rare condition characterized by inflammation of the blood vessels throughout the body, which can lead to vasculitis in various locations, including the neck. It often presents with oral and genital ulcers, and eye inflammation.
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): A rare autoimmune condition that causes vasculitis and is associated with asthma and eosinophilia. It can affect various organs, including those in the neck.
- Polyarteritis nodosa (PAN): A systemic vasculitis that typically affects medium-sized arteries but can involve any size artery, including those in the neck. It's rare and can present with a wide range of symptoms depending on the organs involved.