[Treatment of viral vasculitis]

Necrotizing vasculitis is a heterogeneous group of systemic diseases characterized by inflammation of blood vessel walls. There is current agreement that viral infections can play a central role in the pathophysiology of systemic vasculitides responsible for a broad spectrum of clinical patterns. The hepatitis B and C viruses (HBV and HCV), the parvovirus B19, the human immunodeficiency virus, the HTLV 1, and the cytomegalovirus are the viruses most often implicated. Only the HBV and HCV are associated with fairly well-defined clinical pictures. The conventional management of systemic vasculitis rests on administration of a corticosteroid with an immunosuppressive (usually cyclophosphamide). The decision to treat rests on the nature and severity of the vasculitis. In viral vasculitis, the goal of therapy is to treat both the systemic condition and its cause at the same time. In this situation, conventional immunosuppressive therapy promotes perpetuation of the viral infection, exposing the patient to chronic lesions and to relapses. Antiviral therapy has demonstrated clear evidence of efficacy in vasculitis related to the HBV and, to a lesser degree, the HCV. For the other viruses data, in the literature are scant.