O termo vasculite compreende uma série de condições clínicas heterogêneas, caracterizadas por um processo inflamatório destrutivo acometendo a parede dos vasos sanguíneos. Diferentes tipos de vasos em diversos órgãos podem estar envolvidos, podendo afetar artérias, arteríolas, capilares, vênulas e veias.
As vasculites podem ser secundárias a condições subjacentes de infecções e outros distúrbios, sendo a inflamação vascular, nestes casos, uma manifestação da doença de base. Nas situações em que a vasculite é o processo primário, elas são denominadas de vasculites primárias.
Vimos, ao longo do presente trabalho, que a classificação mais amplamente utilizada diz respeito ao calibre dos vasos afetados, os quais podem ser grandes, médios ou pequenos.Dessa forma, costumam apresentar- se com manifestações clínicas variadas, com sinais e sintomas determinados pelo tipo, tamanho e localização dos vasos acometidos.
Nesse contexto, encontram-se as vasculites paucimunes ANCA- associadas, classificadas como vasculites de pequenos vasos e caracterizadas por inflamação necrosante afetando principalmente capilares, vênulas, arteríolas e pequenas artérias. No cenário das vasculites sistêmicas, o envolvimento pulmonar é mais freqüente nesse subgrupo, foco principal do estudo elaborado. Além da baixa prevalência, seu diagnóstico representa um grande desafio devido à baixa especificidade dos sinais e sintomas, por vezes sobrepostos e facilmente confundidos com os de outras condições.
Embora haja outros tipos de vasculites de pequenos vasos com acometimento pulmonar, o presente trabalho abordou apenas as vasculites ANCA-associadas, onde é mais comumente visto, sendo elas a síndrome de Churg Strauss (SCS), a poliangiite granulomatosa (PAG, antiga granulomatose de Wegener) e a poliangiite microscópica (PAM), considerando os seus aspectos clínicos, radiológicos e histopatológicos.
A epidemiologia, etiologia e patogênese, manifestações clínicas, características histopatológicas e radiológicas, diagnóstico, prognóstico e o tratamento das VAA apresentados no decorrer deste trabalho monográfico, permitem asseverar que se tratam de doenças raras e cujo diagnóstico é
desafiador, devido ao quadro clínico inespecífico, que impõe a realização de um diagnóstico diferencial com diversas outras entidades. Além disso, o diagnóstico precoce é de fundamental importância pelo impacto que produz nos diversos desfechos clínicos, inclusive na mortalidade, para o qual é necessário um alto grau de suspeição clínica, seguida de uma abordagem diagnóstica adequada.
Nesse contexto, desponta a importância da combinação dos aspectos clínicos, radiológicos, laboratoriais e histopatológicos particulares de cada doença para o correto diagnóstico das vasculites, em especial das ANCA- associadas com envolvimento pulmonar, confirmando a hipótese da autora da imprescindibilidade dessa abordagem integrada, não apenas para o adequado diagnóstico, mas também para o eficaz tratamento dessas doenças.
Como corolário dessa conclusão, podemos afirmar que SCS, PAG e PAM, embora guardem entre si algumas características comuns, podem ser diferenciadas com base na correlação clínico-radiológico-patológica e auxílio de exames laboratoriais comprobatórios.
Finalmente, as ideias que consubstanciam as conclusões apresentadas e corroboram a hipótese desta monografia podem ser assim sintetizadas: a abordagem do paciente com presumível vasculite é multidisciplinar; os padrões radiológicos descritos, ainda que possam fornecer pistas diagnósticas, são muitas vezes inespecíficos; e o esforço conjunto de clínicos, radiologistas e patologistas é imprescindível para o adequado diagnóstico e tratamento das VAA.
REFERÊNCIAS
ABERLE, D.R.; GAMSU, G.; LYNCH, D. Thoracic manifestations of Wegener granulomatosis: diagnosis and course. Radiology 1990; 174(3 pt 1):703– 709.
ABRIL, Andy; CALAMIA, Kenneth T.; COHEN, Marc D. The Churg Strauss Syndrome (allergic granulomatous angiitis): review and update. Seminars in Arthritis and Rheumatism 2003; Volume 33, Issue 2, pp 106–114.
AKIKUSA, B.; SATO, T.; OGAWA, M.; et al. Necrotizing alveolar capillaritis in autopsy cases of microscopic polyangiitis: incidence, histopathogenesis and relationship with systemic vasculitis. Arch Pathol Lab Med, 1997; 121:144–149.
ALMEIDA J.L.J.; CAMPOS, L.M.A.; PAIM, L.B.; LEONE, C.; KOCH, V.H.K.; SILVA, C.A.A. Renal involvement in Henoch-Schönlein purpura: a multivariate analysis of initial prognostic factors. J Pediatr. 2007; 83(3): 259-266.
ANTUNES, T.; BARBAS, C.S.V. Granulomatose de Wegener. J Bras Pneumol. 2005; 31(Supl 1):S21-S6.
ARAS, Gülfidan. Recent Aspects of Vasculitis and Future Direction. Internal Medicine 2011. Vol. 50, No. 18 pp.1869-1877.
BARBAS, Carmen Sílvia Valente; BORGES, Eduardo da Rosa; ANTUNES, Telma. Vasculites pulmonares: quando suspeitar e como fazer o diagnóstico. J. bras. pneumol. 2005, vol.31, suppl.1.
BARKSDALE, S.K.; HALLAHAN, C.W.; KERR, G.S.; FAUCI, A.S.; STERN, J.B.; TRAVIS, W.D. Cutaneous pathology in Wegener’s granulomatosis: a clinicopathologic study of 75 biopsies in 46 patients. Am J Surg Pathol 1995; 19(2):161–172.
BOURGARIT, A.; LE TOUMELIN, P.; PAGNOUX, C.; et al; French Vasculitis Study Group. Deaths occurring during the first year after treatment onset for polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: a retrospective analysis of causes and factors predictive of mortality based on 595 patients. Medicine (Baltimore) 2005; 84(5):323–330. BROUET, J.C.; CLAUVEL, J.P.; DANON, F.; KLEIN, M.; SELIGMANN, M. Biologic and clinical significance of cryoglobulins: a report of 86 cases. Am J Med 1974; 57:775–88.
BROWN, Kevin K. Pulmonary Vasculitis. Proc Am Thorac Soc, 2006; 3:48– 57.
BRUCE, I.N., BELL, A.L. A comparison of two nomenclature systems for primary sistemic vasculitis. British Journal of Rheumatology 1997; 36:453- 458.
BURNS, J.C. et al. Sequelae of Kawasaki Disease in Adolescents and Young Adults. J Am Coll Cardiol 1996; 28:253-7.
BUSCHMAN, D.L.; WALDRON, J.A. Jr.; KING, T.E. Jr. Churg-Strauss pulmonary vasculitis. High-resolution computed tomography scanning and pathologic findings. Am Rev Respir Dis 1990; 142:458.
CALAMIA, K.T.; HUNDER, G.G. Clinical manifestations of giant-cell (temporal) arteritis. Clin Rheum Dis 1980; 6: 389-403.
CALVO-ROMERO, J,M. Giant cell arteritis. Postgrad Med J 2003; 79:511– 515.
CHOI, Y.H.; IM, J.G.; HAN, B.K.; et al. Thoracic manifestation of Churg- Strauss syndrome: radiologic and clinical findings. Chest 2000; 117:117. CHUMBLEY, L.C.; HARRISON, E.G.; DEREMEE, R.A. Allergic granulomatosis and angiitis (Churg-Strauss Syndrome): Report and analysis of 30 cases. Mayo Clin Proc 1977;52:477-84.
CHUNG, Man Pyo; YI, Chin A; LEE, Ho Yun; HAN, Joungho; LEE, Kyung Soo. Imaging of Pulmonary Vasculitis. Radiology, May 2010; 255:2.
CHURG, J.; STRAUSS, L. Allergic granulomatosis, allergic angiitis and periarteritis nodosa. Am J Pathol 1951;27:277-301.
CHURG, A. Recent advances in the diagnosis of Churg-Strauss syndrome. Mod Pathol 2001; 14:1284.
CONRON, M.; BEYNON, H.L.C. Churg-Strauss syndrome. Thorax 2000; 55:870–877.
COTTIN, V.; CORDIER, J.F. Eosinophilic pneumonias. Allergy 2005; 60(7):841–857.
D’AGATI, V.; CHANDER, P.; NASH, M.; MANCILLA-JIMENEZ, R. Idiopathic microscopic polyarteritis nodosa: ultrastructural observations on the renal vascular and glomerular lesions. Am J Kidney Dis 1986, 7:95–110. DAJANI, A.S.; TAUBERT, K.A.; GERBER, M.A. et al. Diagnosis and Therapy of Kawasaki Disease in Children. Circulation 1993; Vol 87, No 5.
D’AMICO, G. Renal involvement in hepatitis C infection: cryoglobulinemic glomerulonephritis. Kidney Int 1998;54:650–71.
DAVIES, D.J.; MORAN, J.E.; NIALL, J.F.; RYAN, G.B. Segmental necrotosing glomerulonephritis with antineutrophil antibody: posible arbovirus aetiology. BMJ 1982; 285: 606.4.
DAVIN, J.C.; WEENING, J.J. Diagnosis of Henoch-Schönlein purpura: renal or skin biopsy? Pediatr Nephrol 2003; 18(12):1201-3.
DAVIS, M.D.; DAOUD, M.S.; MCEVOY, M.T.; SU, W.P. Cutaneous manifestations of Churg-Strauss syndrome: a clinicopathologic correlation. J Am Acad Dermatol.1997; 37(2 Pt 1):199-203.
DAVSON, J.; BALL, J.; PLATT, R. The kidney in periarteritis nodosa. QJM, 1948; 17:175–202.
D’CRUZ, D.P.; BARNES, N.C.; LOCKWOOD, C.M. Difficult asthma or Churg- Strauss Syndrome? Br Med J 1999; 318:475-6.
DUNOGUÉ, Bertrand; PAGNOUX, Christian; GUILLEVIN, Loïc. Churg-Strauss Syndrome: Clinical Symptoms, Complementary Investigations, Prognosis and Outcome, and Treatment. Semin Respir Crit Care Med 2011; 32:298– 309.
ERZURUM, S.C.; UNDERWOOD, G.A.; HAMILOS, D.L.; WALDRON, J.A. Pleural effusion in Churg-Strauss Syndrome. Chest 1989; 95: 1357-9.
EVANS, J.M.; HUNDER, G.G. Polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am 2000;26:493–515.
FALK, R.J.; HOGAN, S.; CAREY, T.S. Clinical course of anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and systemic vasculitis. The Glomerular Disease Collaborative Network. Ann Intern Med 1990; 113: 656-63.
FALK, R.J.; JENNETTE, J.C. Anti-neutrophil cytoplasmic autoantibodies with specificity for myeloperoxidase in patients with systemic vasculitis and idiopathic necrotizing and crescentic glomerulonephritis. N Engl J Med 1988; 318: 1651-1657.
FALK, R.J.; GROSS, W.L.; GUILLEVIN, L.; et al. Granulomatosis with polyangiitis (Wegener’s): an alternative name for Wegener’s granulomatosis. Ann Rheum Dis 2011; 70(4):704.
FINKIELMAN, Javier D. et al. ANCA in Active Wegener’s Granulomatosis. The American Journal of Medicine 2007; Vol 120, No 7.
FISCHER, E.G.; LAGER, D.J. Anti-glomerular basement membrane glomerulonephritis: a morphologic study of 80 cases. Am J Clin Pathol 2006; 125(3):445–450.
FRANKEL, Stephen K.; COSGROVE, Gregory P.; FISCHER, Aryeh; MEEHAN, Richard T.; BROWN, Kevin K. Update in the Diagnosis and Management of Pulmonary Vasculitis. Chest, Fev 2006; 129(2).
FRASCA, G.M.; SOVERINI, M.L.; FALASCHINI, A.; et al. Plasma exchange treatment improves prognosis of antineutrophil cytoplasmic antibody- associated crescentic glomerulonephritis: a case-control study in 26 patients from a single center. Ther Apher Dial 2003; 7:540–546.
FREIRE, Beatriz Funayama Alvarenga. Anticorpos anticitoplasma de neutrófilos (ANCA). Botucatu 1997; s.n, 116 p.
FRUSTACI, A.; GENTILONI, N.; CHIMENTI, C.; NATALE, L.; GASBARRINI, G.; MASERI, A. Necrotizing myocardial vasculitis in Churg-Strauss syndrome: Clinicohistogic evaluation of steroids and immunosuppressive therapy. Chest 1998; 114:1484-9.
GASKIN, G.; CLUTTERBUCK, E.J.; PUSEY, C.D. Renal disease in Churg- Strauss Syndrome. Contrib Nephrol 1991; 94:58-65.
GASKIN, G.; PUSEY, C. Plasmapheresis in antineutrophil cytoplasmic antibodyassociated systemic vasculitis. Ther Apher 2001;5:176–181.
GATENBY, P.A.; LUCAS, R.M.; ENGELSEN, O.; PONSONBY, A.L.; CLEMENTS, M. Antineutrophil cytoplasmic antibody-associated vasculitides: could geographic patterns be explained by ambient ultraviolet radiation? Arthritis Rheum 2009; 61(10):1417–1424.
GAYRAUD, M.; GUILLEVIN, L.; LE TOUMELIN, P.; et al. Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum 2001; 44:666.
GIBELIN, Aude; MALDINI, Carla; MAHR, Alfred. Epidemiology and Etiology of Wegener Granulomatosis, Microscopic Polyangiitis, Churg-Strauss Syndrome and Goodpasture Syndrome: Vasculitides with Frequent Lung Involvement. Semin Respir Crit Care Med, 2011; 32:264–273.
GÓMEZ-PUERTA, J.A.; HERNÁNDEZ-RODRÍGUEZ, J.; LÓPEZ-SOTO, A.; BOSCH, X. Antineutrophil cytoplasmic antibody-associated vasculitides and respiratory disease. Chest 2009; 136:1101.
GONZALEZ-GAY, M.A.; GARCIA-PORRUA, C. Epidemiology of the vasculitides. Rheum Dis Clin North Am. 2001;27(4):729-49.
GOODPASTURE, Ernest W. The Significance of Certain Pulmonary Lesions in Relation to the Etiology of Influenza. American Journal of the Medical Sciences, Nov 1919; 158(6):863-870.
GOTTSCHLICH, S.; AMBROSCH, P.; KRAMKOWSKI, D.; LAUDIEN, M.; BUCHELT, T.; GROSS, W.L.; B. HELLMICH. Head and neck manifestations of Wegener’s granulomatosis. Rhinology, 2006; 44, 227-233.
GREEN, R.J.; RUOSS, S.J.; KRAFT, S.A.; BEMY, G.J.; RAFFIN, T.A. Pulmonary capillaritis and alveolar hemorrhage – Update on diagnosis and management. Chest 1996; 110: 1305-16.
GUBBELS, S.P.; BARKHUIZEN, A.; HWANG, P.H. Head and neck manifestations of Wegener’s granulomatosis. Otolaryngol Clin North Am 2003; 36(4):685–705.
GUILLEVIN, Loïc. Clinical trials on systemic necrotizing vasculitides. Presse Med 2010; 39(6):653–659.
GUILLEVIN, Loïc.; COHEN, P.; GAYRAUD, M.; LHOTE, F.; JARROUSE, B.; CASSAUS, P. Churg-Straus Syndrome: Clinical study and long term follow-up of 96 patients. Medicine 1999; 78:26-37.
GUILLEVIN, Loïc; DURAND-GASSELIN, B.; CEVALLOS, R.; et al. Microscopic polyangiitis. Arthritis Rheum 1999; 42:421–430.
GUILLEVIN, Loïc.; LHOTE, F.; GAYRAUD, M.; et al. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome: a prospective study in 342 patients. Medicine (Baltimore) 1996; 75(1):17–28.
GUILLEVIN, Loïc.; LHOTE, F. Polyarteritis nodosa and microscopic polyangiitis. Clin Exp Immunol, 1995; 101(Suppl 1): 22–23.
GUILLEVIN, Loïc; MAHR, Alfred; CALLARD, Patrice; GODMER, Pascal; PAGNOUX, Christian; LERAY, Emmanuelle; COHEN, Pascal. Hepatitis B Virus-Associated Polyarteritis Nodosa: Clinical Characteristics, Outcome, and Impact of Treatment in 115 Patients. Medicine, 2005; Volume 84, Issue 5, 313-322.
GUILLEVIN, Loïc; PAGNOUX, Christian; MOUTHON, Luc. Churg-Strauss Syndrome. Semin Respir Crit Care Med 2004; 25(5):535-545.
GUILLEVIN, L.; PAGNOUX, C.; SEROR, R.; MAHR, A.; MOUTHON, L.; LE TOUMELIN, P. French Vasculitis Study Group (FVSG). The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 2011; 90(1):19–27.
HAGEN, E.C.; DAHA, M.R.; HERMANS, J.; et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization. Kidney Int 1998; 53 (3):743–753.
HALL, S.; BARR, W.; LIE, J.T.; et al. Takayasu arteritis. A study of 32 North American patients. Medicine 1985;64:89–99.
HALL, J.B.; WADHAM, B.M.; EOOD, C.J.; ASHTON, V.; ADAM, W.R. Vasculitis and glomerulonephritis: a subgroup with na antineutrophil cytoplasmic antibody. Aust N Z J Med 1984; 14: 277-278.
HOFFMAN, G.S.; KERR, G.S.; LEAVITT, R.Y.; HALLAHAN, C.W.; LEBOVICS, R.S.; TRAVIS, W.D.; et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992; 116(6):488-98.
HOMER, R.J. Antineutrophil cytoplasmic antibodies as markers for systemic autoimmune disease. Clin Chest Med. 1998; 19(4):627-39.
WOYWODT, A.; HAUBITZ, M.; HALLER, H.; MATTESON E.L. Wegener’s granulomatosis. Lancet 2006; 367(9519):1362–1366.
HUNDER, G.G.; AREND, W.A; BLOCH, D.A.; et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum 1990; 33:1065–7.
HARROLD, L.R.; ANDRADE, S.E.; GO, A.S.; BUIST, A.S.; EISNER, M.; VOLLMER, W.M.; CHAN, K.A.; FRAZIER, E.A.; WELLER, P.F.; WECHSLER, M.E.; YOOD, R.A.; DAVIS, K.J.; PLATT, R. Incidence of Churg-Strauss syndrome in asthma drug users: a population-based perspective. J Rheumatol 2005; 32(6):1076-1080.
HASLEY, P.B.; FOLLANSBEE, W.P.; COULEHAN, J.L. Cardiac manifestations of Churg-Strauss Syndrome: Report of a case and review of the literature. Am Heart J 1990; 120:996-9.
HATTORI N, ICHIMURA M, NAGAMATSU M, LI M, YAMAMOTO K, KUMAZAWA K, et al. Clinicopathological features of Churg-Strauss syndrome-associated neuropathy. Brain 1999;122:427-39.
HAUGEBERG, G.; BIE, R.; BENDVOLD, A.; LARSEN, A.S.; JOHNSEN, V. Primary vasculitis in a Norwegian community hospital: a retrospective study. Clin Rheumatol 1998;17(5):364–368.
JAYNE, D. Evidence-based treatment of systemic vasculitis. Rheumatology (Oxford) 2000; 39:585–595.
JENNETTE, J.C.; FALK R.J. Pathogenic potential of antineutrophil cytoplasmic autoantibodies. Adv Exp Med Biol 1993; 336:7–15.
JENNETTE, J.C.; FALK, R.J.; et al. Nomenclature of systemic vasculitis. Arthritis Rheum. 1994, 37: 187-192.
JENNETTE, J.C.; FALK, R.J. Small-vessel vasculitis. N Engl J Med 1997; 337:1512-23.
JENNETTE, J.C.; FALK, R.J.; ANDRASSY, K.; BACON, P.A.; CHURG, J.; GROSS, W.L.; et al. Nomenclature of systemic vasculitides: proposal of an international consensus conference. Arthritis Rheum, 1994; 37:187–92. JENNETTE, J.C.; FALK, R.J.; GREENBERG, A. Primer on Kidney Diseases, "Vasculitis (Polyarteritis Nodosa, Microscopic Polyangiitis, Wegener's Granulomatosis, Henoch-Schönlein Purpura)". National Kidney Foudation 2005; 4ª Edição, p. 2.0-2.13.
JENNETTE, J.C.; THOMAS, D.B.; FALK, R.J. Microscopic polyangiitis (microscopic polyarteritis). Semin Diag Pathol 2001; 18:3-13.
JOHNSTON, S.L.; LOCK, R.J.; GOMPELS, M.M. Takayasu arteritis: a review. J Clin Pathol 2002;55:481–486.
JONES, N.S. Nasal manifestations of rheumatic diseases. Ann Rheum Dis 1999; 58:589-90.
JUNQUEIRA, L.C.; CARNEIRO, J. Sistema circulatório. In. Junqueira LC. Histologia Básica. 8ª edição. Rio de Janeiro: Guanabara, 1985.
ISHIYAMA, A.; CANALIS, R. Otological manifestations of Churg-Strauss Syndrome. Laryngoscope 2001; 111:1619-24
KALLENBERG, Cees G. M. The Last Classification of Vasculitis. Clinic Rev Allerg Immunol 2008; 35:5–10.
KALLENBERG, Cees G.M.; BROUWER, E.; WEENING, J.J.; COHEN TERVAERT, J.W. Antineutrophil cytolasmic antibodies: current diagnostic and pathophysiologic potential. Kidney Int 1994; 46: 1-15.
KATO, H.; ICHINOSE, E.; KAWASAKI, T. Myocardial infarction in Kawasaki disease: Clinical analyses in 195 cases. J Pediatr 1986; 108:923-927.
KAWASAKI, T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Jpn J Allergy.1967;16:178-222.
KELLY, P.T.; HAPONIK, E.F. Goodpasture syndrome: molecular and clinical advances. Medicine (Baltimore) 1994; 73(4):171–185.
KEOGH, K.A.; SPECKS, U. Churg-Strauss syndrome. Semin Respir Crit Care Med 2006; 27:148.
KERR, G.S.; HALLAHAN, C.W.; GIORDANO, J.; et al. Takayasu arteritis. Ann Intern Med 1994;120:919–29.
KOLDINGSNES, W.; NOSSENT, H. Epidemiology of Wegener’s granulomatosis in northern Norway. Arthritis Rheum 2000; 43(11):2481– 2487.
KUSSMAUL, A.; MAIER, R. Ueber eine bisher micht beschriebene eigenthümliche Arterienerkrankung (periarteritis nodosa) die mit Morbus Brightu und rapid fortschreitender allgemeiner Muskellahmung einhergeht. Dtsch Arch Klin Med 1866; 1:484-518.
LAMPRECHT, P.; GAUSE, A.; GROS, W.L. Cryoglobulinemic vasculitis. Arthritis Rheum 1999; Vol. 42, No. 12, pp 2507–251.
LAMPRECHT, P.; GROSS, W.L. Wegener’s granulomatosis. Herz 2004; 29(1):47-56.
LANDE, A.; BARD, R.; ROSSI, P.; PASSARIELLO, R.; CASTRUCCI, A. Takayasu’s arteritis. A world-wide entity. NY State J Med 1976; 76: 1477-82. LANE, S.E.; WATTS, R.A.; BARKER, T.H.W.; SCOTT, D.G.I. Evaluation of the Sorensen diagnostic criteria in the classification systemic vasculitis. Rheumatology 2002;41:1138–41.
LANGFORD, Carol A.; HOFFMAN, Gary S. Rare diseases.3: Wegener's granulomatosis. Thorax 1999; 54(7):629-637.
LANGFORD, Caro A.; SNELLER, M.C. Biologic therapies in the vasculitides. Curr Opin Rheumatol. 2003; 15(1):3-10. Review.
LANHAM, J.G.; CHURG, J. Churg-Strauss syndrome. In: CHURG A, CHURG J, eds. Systemic Vasculitides. Tokyo: Igaku-Shoin, 1990.
LANHAM, J.G.; ELKON, K.B.; PUSEY, C.D.; HUGHES, G.R. Systemic vasculitis in asthma and eosinophilia: a clinical approach to the Churg Strauss Syndrome. Medicine (Baltimore) 1984; 63:65–81.
LAUQUE, D.; CADRANEL, J.; LAZOR, R.; et al. Microscopic polyangiitis with alveolar hemorrhage: a study of 29 cases and review of the literature. Groupe d’Etudes et de Recherche sur les Maladies “Orphelines” Pulmonaires (GERM”O”P) . Medicine (Baltimore) 2000 ; 79 ( 4 ): 222 – 233 . LEAVITT, R.; FAUCI, A.; BLOCH, D.; et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 1990; 33(8):1101–1107.
LEHMANN, H.; KIEFER, B. Clinical manifestations of Wegener's. granulomatosis. APMIS 1990; 98: 19-20.
LHOTHE, F.; COHEN, P.; GUILLEVIN, L. Syndrome de Churg et Strauss. Maladies et syndromes systemiques. 5e edition. Medecine-Sciences, Flammarion. Paris, 2008; 652-673.
LHOTE, F.; GUILLEVIN, L. Polyarteritis nodosa, microscopic polyangiitis and Churg-Strauss syndrome: Clinical aspects and treatment. Rheum Dis Clin North Am 1995; 21:911-47.
LHOTE, F.; GUILLEVIN, L. Polyarteritis nodosa, microscopic polyangiitis and Churg-Strauss syndrome. Semin Respir Crit Care Med, 1998; 19:27–45. LIE, J.T. Illustrated histopathological classification criteria for selected vasculitis syndromes. Arthritis Rheum 1990; 33:1074-87.
LIM, L.C.L.; TAYLOR, J.G.; SCHMITZ, J.L.; FOLDS, J.D.; WILKMAN, A.S.; FALK, R.J.; et al. Diagnostic usefulness of antineutrophil cytoplasmic autoantibody serology: Comparative evaluation of commercial indirect fluorescent antibody kits and enzyme immunoassays kits. Am J Clin Pathol 1999; 111:363-9.
LIM, Ming Y.; GREENE, Eddie L. 65-Year-Old Woman With Shortness of Breath and Dark Urine. Mayo Clin Proc, Set 2011; 86(9):912-915.
LIU, L-J.; CHEN, M.; YU, F.; ZHAO, M-H.; WANG, H-Y. Evaluation of a new algorithm in classification of systemic vasculitis. Rheumatology 2008; 47:708–712.
LOUTHRENOO, W.; NORASETTHADA, A.; KHUNAMORNPONG, S.; SRESHTHAPUTRA, A.; SUKITAWUT, W. Childhood Churg-Straus Syndrome. J Rheum 1999; 26:1387-93.
LYNCH, J.P.III; MATTESON, E.; MCCUNE, J.W. Wegener’s granulomatosis: evolving concepts. Medical Rounds 1989; 2:67–80.
LYNCH, J.P.III; WHITE, E.; TAZELAAR, Henry.; LANGFORD, C.A. Wegener’s granulomatosis: evolving concepts in treatment. Semin Respir Crit Care Med 2004; 25(5):491–521.
LYNCH, Joseph P.; TAZELAAR, Henry. Wegener Granulomatosis (Granulomatosis with Polyangiitis): Evolving Concepts in Treatment. Semin Respir Crit Care Med 2011;32:274–297.
MAHR, A.; GUILLEVIN, L.; POISSONNET, M.; AYMÉ, S. Prevalences of polyarteritis nodosa, microscopic polyangiitis, Wegener’s granulomatosis, and Churg-Strauss syndrome in a French urban multiethnic population in 2000: a capture-recapture estimate. Arthritis Rheum 2004; 51(1):92–99.
MAHR, A.; ARTIGUES, N.; COSTE, J.; AOUBA, A.; PAGNOUX, C.; GUILLEVIN, L.; French Vasculitis Study Group. Seasonal variations in onset of Wegener’s granulomatosis: increased in summer? J Rheumatol 2006; 33(8):1615–1622.
MAHR, A.D.; NEOGI, T.; MERKEL, P.A. Epidemiology of Wegener’s granulomatosis: Lessons from descriptive studies and analyses of genetic and environmental risk determinants. Clin Exp Rheumatol 2006; 24(2, suppl 41):S82–S91.
MARTIN, R.M.; WILTON, L.V.; MANN, R.D. Prevalence of Churg-Strauss syndrome, vasculitis, eosinophilia and associated conditions: retrospective analysis of 58 prescription-event monitoring cohort studies. Pharmacoepidemiol Drug Saf 1999; 8(3):179–189.
MARVIN, I.S.; KEVIN, K.B. Small vessel vasculitis of the lung. Thorax 2000; 55:502-10.
MASI, A.T.; HUNDER, G.G.; LIE, J.T.; MICHEL, B.A.; BLOCH, D.A.; ARENDT, W.P.; et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss Syndrome (Allergic Granulomatosis and Angiitis). Arthritis Rheum 1990; 33:1094-100
MCMAHON, B.J.; HEYWARD, W.L.; TEMPLIN, D.W.; CLEMENT, D.; LANIER, A.P. Hepatitis B-associated polyarteritis nodosa in Alaskan eskimos: clinical and epidemiologic features and long-term follow up. Hepatology 1989; 9: 97-101.
MONTI, G.; GALLI, M.; INVERNIZZI, F.; PIOTELLI; SACCARDO, F.; MONTEVERDE, A.; et al. Cryoglobulinaemias: a multi-centre study on the early clinical and laboratory manifestations of primary and secondary disease. QJM 1995; 88:115–26.
MOORE, P.M.; CALABRESE, L.H. Neurologic manifestations of systemic vasculitides. Semin Neurol 1994;14:300-6.
NEVES, Sofia; MOTA, Margarida; DIAS, Manuela; RELVAS, Moura; VALENTE, João. Poliarterite nodosa – a propósito de dois casos clínicos. Medicina Interna 2001; Vol. 8, N. 3.
NOTH, I.; STREK, M.E.; LEFF, A.R. Churg-Strauss syndrome. Lancet. 2003; 361(9357):587-594.
OLIVEIRA, S.; MENDONCA, C.; AMBAR, J.; MENDES, B. Síndrome de Churg-Strauss – a propósito de um caso clinico. Rev Port Pneumol. 2005; XI (1): 73-83.
O'SULLIVAN, Brian P.; ERICKSON, Lori A.; NILES, John L. Case 30-2002 — An Eight-Year-Old Girl with Fever, Hemoptysis, and Pulmonary Consolidations. N Engl J Med, 2002; 347:1009-1017.
PEREIRA-SILVA, Jorge Luiz. Vasculites sistêmicas com envolvimento pulmonar. Aula ministrada no Encontro do Clube Manoel de Abreu de São José do Rio Preto, São Paulo, 2011.
PEREIRA-SILVA, Jorge Luiz; KAVAKAMA, Jorge; PORTO, Nelson da S.; SOUZA JUNIOR, Arthur Soares; MARCHIORI, Edson; TERRA FILHO, Mario; ARAUJO NETO, Cesar de; CHAVES, Marcelo; IRION, Klaus L.; JASINOVODOLINSK, Dany; DALTRO, Pedro; NOBRE, Luiz Felipe; FUNARI, Marcelo; ESCUISSATO, Dante L. Diretrizes da SBPT. Consenso Brasileiro sobre a Terminologia dos Descritores de Tomografia Computadorizada do Tórax. Jornal de Pneumologia, São Paulo, 2005; v. 31, n. 2, p. 149-156.
REID, A.J.C.; HARRISON, B.D.W.; WATTS, R.A.; WATKIN, S.W.; MCCANN, B.G.; SCOTT, D.G.I. Churg Strauss Syndrome in a district hospital. Q J Med 1998; 91:219–29.
REINHOLD-KELLER, E.; BEUGE, N.; LATZA, U.; DE GROOT, K.; RUDERT, H.; NOLLE, B.; et al. An interdisciplinary approach to the care of patients with Wegener's granulomatosis: long-term outcome in 155 patients. Arthritis Rheum. 2000;43(5):1021-32.
REZENDE, Carlos E. B. et al. Granulomatose de Wegener: relato de caso. Rev. Bras. Otorrinolaringol, 2003; 69(2).
RODRIGUES, B.F.; ARAÚJO, J.M. Síndrome de Churg-Strauss. 2011; 18(3).
ROSE, G.A.; SPENCER, H. Polyarteritis nodosa. Q J Med 1957;26:43-81.
ROUFOSSE, F.; COGAN, E.; GOLDMAN, M. The hypereosinophilic syndrome revisited. Annu Rev Med 2003; 54:169–184.
SABLÉ-FOURTASSOU, R.; COHEN, P.; MAHR, A.; et al. French Vasculitis Study Group. Antineutrophil cytoplasmic antibodies and the Churg- Strauss syndrome. Ann Intern Med 2005; 143(9):632–638.
SANTOS, J.W.A.; MICHEL, G.T.; PEREIRA, C.E.L.; CAPELOZZI, V.L.; MILETO, J.N.; FIORINI, C.A.; Poliangeíte microscópica com hemorragia alveolar difusa. Jornal Brasileiro de Pneumologia, Mar/Abr 2004; 30(2).
SAVAGE, C.O.S.; HARPER, L.; ADU, D. Primary systemic vasculitis. Lancet 1997; 349:553–8.
SAVAGE, C.O.; HARPER, L.; COCKWELL, P.; ADU, D.; HOWIE, A.J. ABC of arterial and vascular disease: P Vasculitis. BMJ VOLUME 320 13 MAY 2000.
SAVAGE C.O.; WINEARLS, C.G.; EVANS, D.J.; REIS, A.J.; LOCKWOOD, C.M. Microscopic polyarteritis: presentation, pathology and prognosis. Q J Med 1985; 56:467-83.
SAVIGE, JUDY.; DAVIES, DAVID.; FALK, RONALD J.; JENNETTE, J. CHARLES.; AND WIIK, ALLAN. Antineutrophil cytoplasmic antibodies and associated diseases: A review of the clinical and laboratory features. Kidney International, 2000; 57:846–862.
SCHWARZ, Marvin I.; BROWN, Kevin K. Small vessel vasculitis of the lung. Thorax 2000; 55:502–510.
SEHGAL, M.; SWANSON, J.W.; DEREEME, R.A.; COLBY, T.V. Neurologic manifestations of Churg-Strauss Syndrome. Mayo Clin Proc 1995; 70:337- 41.
SILVA JUNIOR, O.F.; FREIRE, E.A.M.; BANDEIRA, F.C.; LEITE, R.R.C.; AMORIM, F.D.B.; LEITE, D.R.C.; COURY, U.L.M.S.M. Poliarterite nodosa: revisão de literatura a propósito de um caso clínico. J Vasc Bras. 2010;9(1):86-89.
SINICO, R.A.; DI TOMA, L.; MAGGIORE, U.; et al. Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome. Arthritis Rheum 2005; 52(9):2926–2935.
SMITH, C.A.; FINDLER, W.J.; PINALS, R.S. The epidemiology of giant cell arteritis. Report of a Ten-Year Study in Shelby County, Tennessee. Arthritis and Rheumatism 1983;26(10):1214-1219.
SOLANS, R.; BOSCH, J.A.; PEREZ-BOCANEGRA, C.; SELVA, A.; HUGUET, P.; ALIJOTAS, J.; et al. Churg-Strauss syndrome: Outcome and long term follow-up of 32 patients. Rheumatology 2001; 40:763-71.
SULLIVAN, E.J.; HOFFMAN, G.S. Pulmonary vasculitis. Clin Chest Med. 1998;19(4):759-76, ix. Review.
TAUBERT, K.A.; ROWLEY, A.H.; SHULMAN, S.T. Seven-year national survey of Kawasaki disease and acute rheumatic fever. Pediatr Infect Dis J.
1994;13:704-708.
TRAVIS, W.D. Pathology of pulmonary granulomatous vasculitis. Sarcoidosis Vasculitis Diffuse Lung Dis 1996; 13:14-27.
TRAVIS, W.D. Pathology of pulmonary vasculitis. Semin Respir Crit Care Med 2004; 25(5):475–482.
TRAVIS, W.D.; HOFFMAN, G.S.; LEAVITT, R.Y.; et al. Surgical pathology of the lung in Wegener’s granulomatosis. Review of 87 open lung biopsies from 67 patients. Am J Surg Pathol 1991; 15:315–33.
TSUCHIYA, N.; KOBAYASHI, S.; HASHIMOTO, H.; OZAKI, S.; TOKUNAGA, K.