Polyarteritis nodosa

Churg Strauss Syndrome

Microscopic Polyangiitis
Wegeners granulomatosis

Polyarteritis nodosa

Picmonic Summary
Polyarteritis nodosa (PAN) is an immune complex-mediated systemic vasculitis of
medium and small arteries. This disease does not typically involve arterioles,
capillaries or venules. It affects various organs in the body including the heart,
liver, GI tract and kidneys, but spares the lungs. Unlike other types of vasculitis
such as Churg Strauss syndrome or Wegeners granulomatosis, PAN is not
associated with antineutrophil cytoplasmic antibodies (ANCAs). However, PAN is
associated with hepatitis B infections. In fact, 30% of patients with PAN have
chronic hepatitis B infections, and antibody complexes to hepatitis B surface
antigens are often found within inflamed vessels.
PAN vessel changes are defined by whats called segmental transmural
necrotizing inflammation. While the disease process may be chronic, during the
acute phase, the inflammation is characterized by infiltration of neutrophils,
mononuclear cells and eosinophils, resulting in whats called fibrinoid necrosis.
Another differentiating characteristic that makes PAN unique compared to the
other vasculitis is that different stages of inflammation can occur simultaneously
due to the recurrent nature of this process.
PAN is characterized by inflammation of the vessels which can lead to infarction,
ulceration, or aneurysm formation anywhere the disease process is taking place.
This disease can affect patients of all ages and can be intermittent, chronic or
acute. Common manifestations include fever, weight loss, hypertension, melena,
myalgia, malaise and peripheral neuritis. The disease process can be controlled
by corticosteroids and cyclophosphamide.
Educational Transcript
Polyarteritis nodosa is depicted in this Picmonic by the polly-artist painting the

Nodosaur. This is an immune complex-mediated systemic vasculitis of small and

medium arteries. Specifically, this vasculitis is described as an immune
complex-mediated transmural vasculitis, shown by the immune complexes on
the vessels-on-fire. A commonly tested fact is that around 30% of patients with
polyarteritis nodosa have chronic hepatitis B, and this association with
hepatitis B is depicted by the happy-tie-liver bee. Polyarteritis nodosa is
associated with fibrinoid necrosis of the arterial wall, illustrated as the fabric
necrosis-crow. Common symptoms of this disease include black stool, or
melena, due to bleeding from the GI tract, shown as the black intestine-stool,
along with neurologic dysfunction, the neuron dysfunctioning. Patients also
complain of myalgias, the mayo-algae, as well as fever, shown by the feverbeaver, and develop hypertension, the hiker-BP. In polyarteritis nodosa,
the blood vessels and lesions involved are often found to have
inflammation of different stages, shown by the vessels and leeches in different
stages. Besides the mesenteric arteries, the renal arteries are also
involved. Inflammation of these arteries results in multiple renal
microaneurysms, which can be visualized on an arteriogram, illustrated as
the kidney with micro-aneurysms. An important fact to remember, is that the
pulmonary arteries are classically spared in polyarteritis nodosa, and
there is no pulmonary involvement, represented by the lungs safe inside the
spare-tire. Polyarteritis nodosa is treated by suppressing the immune system;
initially patients are given corticosteroids, the quarter-on-steroids. An
antineoplastic medication, cyclophosphamide, shown as the cyclops-phosphateP, is also helpful in treating this disease, as this drug also works to suppress
immune-mediated inflammation.
So to sum it up, polyarteritis nodosa is an immune complex-mediated transmural
vasculitis. Remember that this disease is associated with hepatitis B, and causes
fibrinoid necrosis. Signs and symptoms include melanotic, black stools, neurologic
dysfunction, and myalgias. Patients also develop fever and hypertension.
Diagnosis is made when we see vessels or lesions in different stages of
inflammation, and on arteriogram we see renal microaneurysms. Don't forget that
this inflammatory syndrome spares the pulmonary arteries. Polyarteritis nodosa is
treated with corticosteroids, along with cyclophosphamide.
Story Transcript
This polly-artist has a special talent. He can turn anything he paints to
life. But things go horribly wrong when he tries to paint his favorite
dinosaur, the Nodosaur. As soon as he painted the last stroke, the nodosaur
began breathing fire and viciously destroyed pollys home, leaving what was once
a flourishing forest to nothing but bare branches of immune complexes of
vessels-on-fire. His fellow flying friends, happy-tie-liver bee and the fabric
necrosis-crow, were lucky to make it out alive. Polly sat on the edge of his black
stool and pondered how his magical neuron paintbrush could malfunction so
badly. This neuron dysfunction is ruining everything! Thats when he realized he
wasnt painting with paint, but mayo-algae! It was his fault that the Nodosaur set
his beaver buddy on fire, and now attempts to put out the flame with a hiker-BP.
His poor dam of vessels was destroyed as well, and left to the destruction of
leeches all different ages.This leads to a trickle of a stream, causing microaneurysms to build up in the kidney bank. The lungs discovered this with

his microscope and quickly rolled away to safety in a spare-tire and sought
help from the quarter-on-steroids wielding giant, Cyclops-phosphate-P.

Wegeners granulomatosis

Picmonic Summary
Wegeners granulomatosis, more recently termed granulomatosis with
polyangiitis, is a small and medium vessel necrotizing vasculitis that typically
affects the nose, lungs, and kidneys. Wegeners is characterized by granulomatous
inflammation against a nonspecific inflammatory background thought to be
caused by the presence of C-ANCA or cytoplasmic anti-neutrophil cytoplasmic
antibodies. These antibodies react with proteinase 3, an enzyme within neutrophil
granulocytes. The lungs and upper airways are classically involved and can cause
chronic sinusitis, otitis media, perforation of the nasal septum, and saddle nose
deformity. Individuals also commonly complain of cough and hemoptysis. The
kidneys are also classically involved and can cause glomerulonephritis with
hematuria. Cyclophosphamide and corticosteroids can be used as immune
suppressants in the treatment of granulomatosis with polyangiitis.
Educational Transcript
Wegener's granulomatosis, portrayed by the wagon and the granny llama, is a
small and medium vessel vasculitis that typically affects the nose, lungs and
kidneys. Involvement of the lungs, shown by the lungs in the wagon, can cause
cough, the coughing-coffee, and hemoptysis, depicted by the red mop and the
sinner character coughing up blood. The upper airways are also classically
involved and can lead to chronic sinusitis, portrayed by the sinner with large
nose, and otitis media, oats in the ear. Chronic inflammation of the nose and
sinuses can lead to a saddle nose deformity, shown by the grandma sitting on the
saddle placed on the nose, as well as perforation of the nasal septum,
illustrated by the large nose-ring on the sinusitis sinner. The kidneys are also
classically involves and can cause glomerulonephritis, the glowing mare, with

hematuria, shown by the glowing mare making red urine.

Story Transcript
Getting ready to hop back on the vascular wagon to transport their precious
cargo, sinusitis sinner can't figure out how he ever got conned into this job. All he
wanted was granny llama's ring for his nose and he ended up being a stable boy
and personal waiter he's been mopping up the horses red urine, to providing a
healthy breakfast of ear oats and coffee. The glow mare seems to think his
predicament is hilarious. All the while granny and her lama kick back on their
saddle nose and let him do all their work.

Wegeners granulomatosis

Picmonic Summary
Wegeners granulomatosis, more recently termed granulomatosis with
polyangiitis, is a small and medium vessel necrotizing vasculitis that typically
affects the nose, lungs, and kidneys. Wegeners is characterized by granulomatous
inflammation against a nonspecific inflammatory background thought to be
caused by the presence of C-ANCA or cytoplasmic anti-neutrophil cytoplasmic
antibodies. These antibodies react with proteinase 3, an enzyme within neutrophil
granulocytes. The lungs and upper airways are classically involved and can cause
chronic sinusitis, otitis media, perforation of the nasal septum, and saddle nose
deformity. Individuals also commonly complain of cough and hemoptysis. The
kidneys are also classically involved and can cause glomerulonephritis with
hematuria. Cyclophosphamide and corticosteroids can be used as immune
suppressants in the treatment of granulomatosis with polyangiitis.
Educational Transcript
Wegeners granulomatosis, shown by the wagon with the granny and the llama,
is a small and medium vessel vasculitis more recently termed granulomatosis
with polyangiitis, portrayed by the granny llama with poly the parrot angel for
polyangiitis. This vasculitis, which is portrayed by the vessels on the wagon, is
commonly described as a necrotizing vasculitis, the necrosis crow grabbing at
the vessels. Wegeners granulomatosis is characterized by the presence of C anca
antibodies, shown by the C shaped anchor, which is thought to play a role in the
pathophysiology of the disease. The lungs and upper airways, shown by the
lungs and airways in the wagon, are classically involved as well as the kidneys,
which can lead to crescentic glomerulonephritis, portrayed by the crescent

moon on the glowing mare. Cyclophosphamide, the Cyclops-phosphate-Ps, and

corticosteroids, the quarter-on-steroids, can be used as immune suppressants in
the treatment of this disease.
Story Transcript
It's a dangerous frontier for wagoneers! This granny llama and her polly angel
ride for their lives, pulled by the crescent branded glow mare, as they make their
escape with stolen lungs in their blood vessel wagon. They've awoken the
mythical cyclops phosphate P, and he summons a necrosis crows to attack the
vessels on the wagon and attaches a C anchor to slow them down. Now, with the
cyclops gaining on them, he throws a quarter on steroids to finish the job. Rule
#78 in the wagoneers hand book, don't steal lungs from mythical creatures

Microscopic Polyangiitis;

Picmonic Summary
Microscopic Polyangiitis is an autoimmune small vessel vasculitis affecting
multiple organs in the body. Common causes of microscopic polyangiitis include
autoimmune disorders, systemic lupus erythematosus, streptococcus infections
and penicillin use. These conditions, infections and medications act as triggers to
cause microscopic polyangiitis in patients who are genetically susceptible. The
small vessel inflammation leads to disease manifestation in the brain, lungs,
intestines and kidneys. Due to inflammation in the vessels of these organs,
patients present with neurological defects, pulmonary symptoms, abdominal pain
and possibly renal failure. A unique finding in this disease is that the vessels
affecting the various organs occur at the same stage during the disease process.
The skin manifestation is called a palpable purpura which are lesions that appear
as red or purple discolorations on the skin that do not blanch on applying
pressure. This disease can be detected by the presence of perinuclear anti
neutrophilic cytoplasmic antibodies (P-ANCA) which are antibodies against
myeloperoxidase in cells.
Educational Transcript
Microscopic polyangiitis, depicted by the microscope Polly-angel, is a
necrotizing small vessel vasculitis, which is demonstrated by the necrosiscrow with the small vessels-on-fire. Common causes of microscopic polyangiitis
include infections like streptococci, drugs like penicillin and autoimmune
disorders like lupus. Now, with this disorder, the lungs, kidneys and skin are
commonly affected, depicted as the lungs, kidney, and skin-suit-man. Moreover,
on the skin, patients with microscopic polyangiitis get palpable purpura, the

palpable-paw-print from the purple-cat. Furthermore, microscopic polyangiitis is

associated with the development of rapidly progressive crescentic
glomerulonephritis, shown as the rapids with the crescent-kayak glow-mare.
When diagnosing this vascular disease, tissue biopsy will show that the small
vessel lesions are in the same stage of inflammation, and thus the lesions are
the same age, the leeches from the same age-egg. This contrasts the different
staged lesions in polyarteritis nodosa. Additionally, the inflammation observed in
microscopic polyangiitis is non-granulomatous, the nun-granny-llama. A notable
diagnostic feature of this disease is that there is minimal nasopharyngeal
involvement, the minimal nose-pharaoh, and this contrasts granulomatosis with
polyangiitis, in which the majority of cases involve the nasopharynx. On ELISA,
we see that patients are positive for p-ANCA, or perinuclear antibodies, shown as
the PANCake. Microscopic polyangiitis is treated via immunosuppression with
corticosteroids, the quarter-on-steroids, and typically, cyclophosphamide is
used in combination, illustrated by the cyclops-phosphate-P.
So in short, microscopic polyangiitis is a necrotizing small vessel vasculitis in
which the lungs, kidneys and skin are commonly affected. Patients display a
palpable purpura, and this disease is linked with the development of rapidly
progressive crescentic glomerulonephritis. We can distinguish this vasculitis from
others when we see that the lesions in microscopic polyangiitis are the same age,
and are non-granulomatous. There is minimal nasopharyngeal involvement, and
patients are P-ANCA positive. Treatment consists of corticosteroids in
combination with cyclophosphamide.
Story Transcript
For microscopic polyangiitis, imagine this microscope Polly-angel up in heaven.
And she's using a microscope to keep a watchful eye on this necrosis-crow down
in hell, with these tiny little vessels-on-fire, representing necrotizing small
vessel vasculitis. And through this microscope, the Polly spies these small vessels
attacking a few of the organs most vulnerable to small vessel vasculitis. She sees
the lungs screaming bloody murder. A kidney, unable to filter its fear. And a
guy in a skin-suit, covered in palpable-paw-prints from a purple-cat,
representing palpable purpura. Their boat was capsized along this bloodstream,
and the cat climbed up his skin-suit to keep dry. And this occurred just as they
were floating through the rapids of this bloodstream, on a crescent shaped
kayak with a glow-mare, for rapidly progressive crescentic glomerulonephritis.
At this point, the crow hatches an egg, releasing leeches of the same age unto
the world, illustrating lesions of the same age. And these leeches go straight for a
nun-granny on a llama, representing non-granulomatous. She cries out for
help, but a pharaoh on the shoreline runs away so fast, he leaves behind his
nose, for minimal nasopharyngeal involvement. So the nun does what nuns do
and prays. And just in the knick of time, her prayers are answered. With
pancakes, for P-ANCA, which come flying down from heaven and the leeches
start eating them instead. See, the Polly angel keeps her own muscle around to
deal with this necrotic crow. There's a quarter-on-steroids, for corticosteroids.
And he throws these pancakes at the leeches as they're spotted by a cyclops
with a giant phosphate-P for an eye, representing cyclophosphamide.

Churg Strauss Syndrome

Picmonic Summary
Churg Strauss Syndrome is a small and medium vessel autoimmune vasculitis.
Diagnostic markers include eosinophilic granulomas and p-ANCA. Churg Strauss
typically presents in 3 stages. The first stage of disease involves the sinuses and
the onset or worsening of pre-existing allergies. The second stage involves the
onset of acute asthma. The third stage involves various organ systems including
vessels of the lungs, GI tract, and peripheral nerves. Churg Strauss can also affect
the heart and kidneys. Often the disease will cause severe nerve pain or
peripheral neuropathy.
Educational Transcript
Churg strauss syndrome, portrayed by the church of straws, is a
granulomatous vasculitis, illustrated by the granny llama grabbing vessels. It
commonly presents with sinusitis, shown as the sinner with a large nose, skin
lesions, the skin leeches, and peripheral neuropathy, the purple wavy neuron
arms. Asthma, depicted by the inhaler, is also a common presentation with
abundance of eosinophils, the red eagle, in the blood. Organs involved include
the GI tract, heart, and kidneys. 70% of patients demonstrate a positive P-anca,
the pancakes, on lab findings.
Story Transcript
The church of straws serves as a refuge for those trying to resist the sinus sinner.
And he should know by now that he isn't winning anyone over with those skin
leeches. The sinner attacked with his wavy peripheral when granny llama arrived
to get pancakes. But he really only wants their inhaler for his burning lungs. The

granny really put him in his place with her vessels as soon as she returned. The
kidney, heart, and G.I. guy should stop being so happy about pancakes and take a
moment to help granny though, because there's an eagle who wants those
pancakes just as bad.