Necrotizing Vasculitis: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Necrotizing Vasculitis?
Rheumatologists, doctors who treat immune system and joint diseases, usually lead care for necrotizing vasculitis. Kidney, lung, or skin doctors may also help, depending on the organs affected. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is necrotizing vasculitis?
Necrotizing vasculitis is a group of disorders that involve inflammation of the blood vessel walls. Inflammation is swelling and irritation. The size of the affected blood vessels helps to determine the names of these conditions.
The wall of the blood vessel may scar and thicken, or it may die. The vessel may close, which interrupts blood flow to the tissues it supplies. Without blood flow, the tissues die. Sometimes the vessel breaks and bleeds.
It may affect blood vessels in any part of the body. So it can cause problems in the skin, brain, lungs, intestines, kidney, joints, or any other organ.
Symptoms
Fever, chills, fatigue, arthritis, or weight loss may be the only symptoms at first. Symptoms may be in almost any part of the body. They can include:
- Red or purple bumps on the legs, hands, or other parts of the body.
- Bluish color to the fingers and toes.
- Skin ulcers that do not heal.
- Joint pain.
- Leg pain.
- Tingling in an arm, leg, or other body area.
- Cough, shortness of breath, or sinus congestion and pain.
- Abdominal pain.
- Blood in the urine or stools.
Causes and who gets it
The cause of the inflammation is unknown. It is likely related to autoimmune factors. In vasculitis, the immune system attacks the blood vessel by mistake.
Necrotizing vasculitis may be the main condition, such as in people with polyarteritis nodosa. In other cases it occurs as part of another disorder, such as systemic lupus erythematosus or hepatitis C.
Vasculitis in general can happen because of an infection, a medicine, or another disease.
How doctors diagnose it
The provider does a complete physical exam. A nervous system exam may show signs of nerve damage. Tests that may be done include:
- A complete blood count.
- Blood tests for inflammation, such as C-reactive protein and erythrocyte sedimentation rate.
- Blood tests for ANCA antibodies, which are antibodies against certain white blood cells.
- A hepatitis blood test.
- Urinalysis, which is a urine test.
- A chest x-ray.
- Imaging, such as an ultrasound, CT scan, or MRI.
- A biopsy, which is a small tissue sample, of the skin, muscle, organ tissue, or nerve.
Treatment
The main goal of treatment is to stop the inflammation. Corticosteroids, which are strong anti-inflammatory medicines, are given in most cases.
Other medicines that suppress the immune system may reduce inflammation of the blood vessels. These include azathioprine, methotrexate, and mycophenolate. They are often used with corticosteroids. This makes it possible to control the disease with a lower dose of corticosteroids.
For severe disease, cyclophosphamide has been used for many years. Rituximab is equally effective and is less toxic than cyclophosphamide.
Problems can come from the disease and from the medicines. Most forms need long-term follow-up and treatment.
When to see a doctor
Contact your provider if you have symptoms of necrotizing vasculitis.
Call 911 or go to the emergency room right away. MedlinePlus lists these emergency symptoms:
- A stroke or coughing up blood.
- Changes in pupil size.
- Loss of function of an arm, leg, or other body part.
- Speech problems, trouble swallowing, or sudden weakness.
- Severe abdominal pain.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can review your symptoms and order first blood and urine tests. They can also help you keep up with specialist visits, since this condition needs long-term follow-up.
Common questions
Is necrotizing vasculitis serious?
Yes, it can be a serious and life-threatening disease. The outcome depends on the location of the vasculitis and the severity of tissue damage.
Does necrotizing vasculitis affect only one part of the body?
No. It may affect blood vessels in any part of the body. Symptoms depend on which organs are affected.
What medicines treat necrotizing vasculitis?
Medicines for this condition include corticosteroids, which are given in most cases. Doctors may add other medicines that suppress the immune system.
Can necrotizing vasculitis be prevented?
No known way to prevent it exists, according to MedlinePlus.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
