Systemic necrotizing vasculitis in necropsy

Objective. To analyze the characteristics of systemic necrotizing vasculiti s observed in necropsy emphasizing the non-diagnosed cases until nercropsy and to identify the reasons of clinical confusion. Materials and methods. Necropsies of adult patients performed in Hospital G eneral La Paz, Madrid, from 1966 to 1977 were reviewed. Clinical manifestat ions, analytical changes and involvement of different organs were analyzed. The correspondence degree between clinical and necropsic diagnoses was stu died. Results. A total of 18 cases of necrotizing vasculitis were observed out of 3,980 necropsies. The most common clinical manifestations were fever and g eneral syndrome (60%). The organs most commonly involved were kidney (94%) and gastrointestinal tract (56%). Diagnosis was revealed by necropsy in 39% of cases; in these cases, the incidence of heart failure and peripheral ne uropathy was significantly lower, whereas digestive hemorrhage and liver, p ancreas, adrenal gland, and bladder involvement was significantly higher. Conclusions. Systemic necrotizing vasculitis in underdiagnosed, which can b e partly explained by the lack of specificity of the most common symptoms a nd the paucity of characteristic clinical and organ-specific manifestations which leads to confusion with more prevalent conditions.