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CSS manifests with signs and symptoms similar to PAN except that respiratory involvement is common in CSS1,2,30 34 The incidence is of CSS in about one-third that of PAN, but the frequency of neurological complications is about the same In this regard, multiple mononeuropathies develop in as many as 75% of individuals who are affected2 People with CSS typically present with allergic rhinitis, nasal polyposis, sinusitis, and late-onset asthma (after the age of 35 years) Symptoms and signs of systemic vasculitis occur at an average of 3 years after the onset of asthma Anywhere from 16% to 49% of patients with CSS develop a necrotizing glomerulonephritis as opposed to an ischemic nephropathy that can complicate PAN Several cases of CSS have been reported in patients treated with leukotriene antagonists after weaning corticosteroids35 Routine laboratory workup reveals eosinophilia, leukocytosis, elevated ESR, C-reactive protein, rheumatoid factor, and serum IgG and IgE levels One should be suspicious of the diagnosis of CSS in any patient with a neuropathy and peripheral eosinophilia Approximately two-thirds of individuals who are affected also have positive antineutrophil antibodies (ANCAs), primarily myeloperoxidase or p-ANCA, because of its perinuclear staining pattern2 Chest X-rays reveal that pulmonary in ltrates are present in nearly half of the patients Nerve biopsies may demonstrate necrotizing vasculitis with CD8+ cytotoxic T lymphocytes, CD4+ cells, and to a lesser extent eosinophilic in ltrates (Fig 13 4)2,32,36 In addition, intravascular and extravascular

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Wegener granulomatosis is characterized by necrotizing vasculitis and granulomas involving the upper and lower respiratory tract and kidneys (glomerulonephritis)1,4,37 44 Early respiratory symptoms (eg, nasal discharge, cough, hemoptysis, and dyspnea) can help distinguish this from other vasculitides In a large prospective study of 128 patients with Wegener s granulomatosis, 64 patients (50%) developed CNS or PNS involvement37 Peripheral neuropathy occurred in 56 patients and in nine cases the CNS was involved Thirty-one patients had a distal symmetrical polyneuropathy, while 25 had multiple mononeuropathies Neuropathy is more common in patients with severe renal involvement41 Cranial neuropathies, particularly the second, sixth, and seventh nerves, develop in approximately 5 10% of cases as a result of extension of the nasal or paranasal granulomas rather than vasculitis37,43 The majority of individuals who are affected have ANCAs directed against proteinase-3 in their sera, and this test has a speci city of 98% and sensitivity of 95%41 The histological appearance of the vasculitis is similar to PAN, with involvement of medium- and small-sized blood vessels In addition, granulomatous in ltration of the respiratory tract and necrotizing glomerulonephritis are also seen The absence of peripheral eosinophilia, eosinophilic in ltrates on biopsy, and asthma help distinguish Wegener s granulomatosis from CSS

Microscopic polyangiitis (MPA) clinically resembles PAN and CSS, except that diffuse alveolar damage and interstitial brosis develop due to involvement of pulmonary capillaries1,2,4,32,33,45 The incidence of MPA is about one-third that of PAN The average age of onset of 50 years and polyneuropathy complicates MPA in 14 36% of cases2,4,45 Laboratory evaluation is remarkable for renal insuf ciency, hematuria, and p-ANCAs in most patients C-ANCAs can also occasionally be detected As suggested by the name, MPA affects small arterioles, venules, and capillaries2,4 In contrast to PAN, there are few or no immune deposits on the blood vessels Kidney biopsies reveal focal segmental thrombosis and necrotizing glomerulonephritis

Use the Device Emulator Manager (dvcemumanagerexe) for choosing between images and controlling image power on/power off state (see Figure 4-3) This tool is installed with the emulator and can control all the currently installed images Images can be started, stopped, and cradled from within this tool There is also a command-line tool (DeviceEmulatorexe) for controlling individual images; this executable is installed in the emulator s program files directory In addition to the GUI and command-line interfaces, Device Emulator 30 introduces the IDeviceEmulatorManager COM interface This interface can be used to discover currently installed images and control them If you re performing fuzzing or other repetition-based testing, the COM interface is helpful for controlling images

with acquired immune de ciency syndrome (AIDS)54 As previously discussed, hepatitis B and C infections are associated with PAN, a medium-sized systemic vasculitis, as well as a small vessel vasculitis associated with cryoglobulinemia Vasculitic neuropathy may also complicate Lyme disease

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