Necrotizing Angiitis: III. Correlation of Clinical Findings With Biopsy Evidence in Thirty-One Patients

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THE presence of vasculitis in biopsy specimens can be of great help in the diagnosis of obscure clinical problems. The difficulty in obtaining a diagnostic biopsy is reflected in the paucity of published antemortem tissue diagnoses of generalized necrotizing angiitis. Patalano and Sommers1 reported 30 autopsied cases of polyarteritis nodosa, yet in only one had there been an antemortem diagnosis. In another study2 it was found that only one of 15 antemortem biopsies was positive in patients proved to have necrotizing angiitis at autopsy. Maxeiner, McDonald, and Kirklin3 found that 92 percent of biopsy specimens of muscle taken at random were negative, and the presence of a nodule was suggestive but no guarantee that a lesion would be found. The difficulties are compounded by the focal nature of the lesion in the vessel and by the limitations apparently inherent in biopsy methods.4

It is clear that necrotizing angiitis can be a rapidly fatal disease in many instances. In regard to the series of 30 patients with “allergic vasculitis,” reported by McCombs, Patterson, and MacMahon,5 four died of anal failure. Winkelmann and Ditto6 evaluated 38 cases of cutaneous vasculitis and found that vascular disease caused four deaths. An even more ruinous diagnosis than necrotizing angiitis or vasculitis is that of ‘periarteritis nodosa’: death occurred within a few years in the majority of patients .5

On the other hand, severe disease may be evident in a vessel involved in oral inflammatory processes or may be limited to vessels of one organ with. . .



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