"Vasculitis look-alike" clinical syndromes

Rheumatologists are sometimes asked to see patients with severe manifestations of vascular syndromes termed "pseudovasculitis," which often closely mimic autoimmune vasculitis. These syndromes include cholesterol embolism, fibromuscular dysplasia, antiphospholipid syndrome, ergotism, neurofibromatosis, and primary amyloidosis. In patients with suspected vasculitis, sometimes dramatic clinical findings may require urgent decision-making before all testing has been concluded. These circumstances make it particularly important for the clinician to consider pseudovasculitis in the differential diagnosis. Our review describes the common presentations of pseudovasculitis-which may include fever, weight loss, weakness, hypertension, and vascular occlusions-and emphasizes on their diagnostic features. A careful history and physical examination, laboratory and radiographic studies, as well as a high level of suspicion will help the clinician to consider pseudovasculitis in which treatment with immunosuppressive agents such as high dose corticosteroids or cytotoxic agents would be contraindicated and possibly disastrous.