What disorders can mimic vasculitis?
The following disorders can mimic vasculitis (common clinical entities in italics):
Large arteries: fibromuscular dysplasia , atherosclerosis , radiation fibrosis, neurofibromatosis type I, congenital coarctation of aorta, genetic diseases (Marfan syndrome, Loeys–Dietz syndrome), syphilitic aortitis, IgG4 disease, inflammatory aortic aneurysm, and sarcoidosis.
Medium arteries: cholesterol emboli syndrome , atrial myxoma , fibromuscular dysplasia , lymphomatoid granulomatosis, angioblastic T-cell lymphoma, thromboembolic disease, ergotism, type IV Ehlers–Danlos syndrome, segmental arterial mediolysis, Grange syndrome, and pseudoxanthoma elasticum.
Cerebral arteries: reversible cerebral vasoconstrictive syndrome , reversible posterior encephalopathy syndrome , cerebral amyloid angiopathy, CADASIL syndrome, Susac syndrome, progressive multifocal leukoencephalopathy, Moyamoya disease, intravascular B-cell lymphoma, and infections.
Small arteries: Infectious endocarditis, mycotic aneurysm with emboli, cholesterol microemboli syndrome, antiphospholipid antibody syndrome, sepsis (gonococcal, meningococcal), neoplasia (lymphoma, myeloproliferative, sold tumor), ecthyma gangrenosum (Pseudomonas), thrombotic thrombocytopenia purpura, cocaine, amphetamines, minocycline, hydralazine, HIV, hepatitis C, amyloidosis, systemic rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus [SLE], Sjögren’s syndrome), bacteremias (SBE, Rickettsia), other systemic viral infections, common variable immunodeficiency, calciphylaxis, livedoid vasculopathy (atrophie blanche), malignant atrophic papulosis (Degos disease), sickle cell disease, inflammatory bowel disease, and sarcoidosis.
To rule out vasculitis mimics requires a good history and physical exam. Consider blood cultures, viral hepatitis studies, HIV testing, urinary toxicology screening, echocardiography, antinuclear antibody (ANA), rheumatoid factor (RF), antiphospholipid antibodies, and/or angiography/magnetic resonance angiography, depending on the clinical situation.
