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Jayaprakash V, Mathew GG, Muthukarupiah S, Sailapathy S, Ramakrishnan R. A rare case of dialysis associated reaction presenting with urticarial vasculitis and haemoglobinuria. Nephrology (Carlton) 2024; 29:235-238. [PMID: 38173049 DOI: 10.1111/nep.14267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Dialysis associated reactions presenting with urticarial vasculitis is rarely reported in medical literature. We report a 61-year-old gentleman who developed sudden onset dyspnea with diffuse erythema within 20 min of haemodialysis. Patient was started on Azilsartan 3 days prior to this clinical event. Labs revealed features of hemolysis and urine was positive for hemoglobinuria. All dialysis related factors responsible for this reaction were ruled out. Due to non-resolution of skin rash, skin biopsy was attempted which revealed fibrinoid necrosis of occasional vessels with predominant lymphocytic infiltration suggestive of drug induced urticarial vasculitis. Complement levels were normal. He was managed with steroids, anti-histaminic, discontinuation of azilsartan and change of dialyzer membrane. This case highlights a rare dermatological presentation of Type A dialysis associated reaction involving azilsartan with differential diagnosis and treatment strategies.
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Affiliation(s)
- Varadharajan Jayaprakash
- Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India
| | - Gerry George Mathew
- Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India
| | - Suganya Muthukarupiah
- Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India
| | - Sreedhar Sailapathy
- Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India
| | - Ramachandran Ramakrishnan
- Department of Dermatology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India
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2
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Alarnaouti M, Alfaer S, Tallab M, Khojah AA, Magadmi T, Kadasa A, Binsaqr MA. Urticarial Vasculitis Induced by Adalimumab Biosimilar in an Elderly Female With Hidradenitis Suppurativa: A Case Report. Cureus 2024; 16:e57722. [PMID: 38711695 PMCID: PMC11073587 DOI: 10.7759/cureus.57722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
Urticarial vasculitis (UV) is a type of small-vessel vasculitis, which is rarely associated with anti-tumor necrosis factor (TNF)-alpha medication. We describe a 72-year-old woman with multiple comorbidities on several medications, including an adalimumab biosimilar for Hurley stage II recalcitrant hidradenitis suppurativa (HS), who presented with new-onset severe angioedema and a rash with urticarial wheals that covered most of her body surface area. The diagnosis of drug-induced UV is supported by both the history of adalimumab biosimilar use and the histopathology result. The patient responded successfully to a course of doxycycline administered for three months, which was preceded by corticosteroid dosages, both orally and intravenously, to reduce inflammation. The given case highlights the correlation between a distinct dermatologic autoimmune manifestation and TNF-targeted therapy, demonstrating the importance for dermatologists to be aware of the potential side effects of adalimumab biosimilars in order to manage them effectively.
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Affiliation(s)
| | - Sultan Alfaer
- Department of Dermatology, King Fahad General Hospital, Jeddah, SAU
| | - Mawaddah Tallab
- Department of Dermatology, King Fahad General Hospital, Jeddah, SAU
| | | | - Talah Magadmi
- College of Medicine, King Abdulaziz University, Jeddah, SAU
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3
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Young JN, Rivera-Oyola R, Poplausky D, Suemitsu Y, Kim RH, Doroshow D, Gulati N. A case of urticarial vasculitis associated with atezolizumab. JAAD Case Rep 2024; 43:30-33. [PMID: 38162407 PMCID: PMC10757233 DOI: 10.1016/j.jdcr.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Jade N. Young
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Rivera-Oyola
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dina Poplausky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yamato Suemitsu
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Randie H. Kim
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah Doroshow
- Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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4
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Krause K, Bonnekoh H, Jelden‐Thurm J, Asero R, Gimenez‐Arnau AM, Cardoso JC, Grattan C, Kocatürk E, Lippert U, Maurer M, Metz M, Staubach P, Goncalo M, Kolkhir P. Differential diagnosis between urticarial vasculitis and chronic spontaneous urticaria: An international Delphi survey. Clin Transl Allergy 2023; 13:e12305. [PMID: 37876033 PMCID: PMC10587388 DOI: 10.1002/clt2.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Urticarial vasculitis (UV) should be differentiated from chronic spontaneous urticaria (CSU) in patients initially presenting with recurrent wheals, although criteria for differential diagnosis remain ill-defined. OBJECTIVES To set the goals, define criteria and unmet needs in UV diagnosis and differential diagnosis with CSU, and explore the possibility of coexistence of both diseases. METHODS Thirteen experts experienced in UV research participated in a Delphi survey of European Academy of Allergy and Clinical Immunology taskforce. This Delphi survey involved three rounds of anonymous responses to n = 32 questions with the aim to aggregate the experts' opinions and to achieve consensus. Urticaria specialists (n = 130, most from Urticaria Centers of Reference and Excellence) evaluated the consensus statements and recommendations in the fourth and final round. RESULTS The panel agreed that essential criteria to guide a skin biopsy in patients with recurrent wheals should include at least one of the following features: wheal duration >24 h, bruising/postinflammatory hyperpigmentation, and systemic symptoms. Leukocytoclasia and fibrin deposits were identified as a minimum set of UV histological criteria. As agreed by the panel members, CSU and normocomplementemic UV (NUV) may coexist in some patients. CONCLUSIONS The use of established criteria for the diagnosis and differential diagnosis of UV in patients with recurrent wheals can help guide the diagnostic approach and prompt earlier treatment. Further studies should investigate whether CSU and NUV are different entities or part of a disease spectrum.
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Affiliation(s)
- Karoline Krause
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Hanna Bonnekoh
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Jannis Jelden‐Thurm
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Riccardo Asero
- Ambulatorio di AllergologiaClinica San CarloPaderno DugnanoItaly
| | | | - José C. Cardoso
- Department of DermatologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Clive Grattan
- Guy's HospitalSt John's Institute of DermatologyLondonUK
| | - Emek Kocatürk
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
- Department of DermatologyKoç University School of MedicineIstanbulTurkey
| | - Undine Lippert
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Martin Metz
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Petra Staubach
- Department of DermatologyUniversity Medical Center MainzMainzGermany
| | - Margarida Goncalo
- Department of DermatologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Pavel Kolkhir
- Institute of AllergologyCharité – Universitätsmedizin Berlincorporate member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlin Institute of HealthBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
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5
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Teles C, Gaspar E, Gonçalo M, Santos L. Normocomplementemic urticarial vasculitis secondary to Lyme disease: A rare association with challenging treatment. J R Coll Physicians Edinb 2023; 53:27-29. [PMID: 36519641 DOI: 10.1177/14782715221144167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Urticarial vasculitis (UV) is a rare entity characterised by long-lasting recurrent episodes of urticarial lesions. Although frequently idiopathic, UV has been associated with multiple diseases, including infections. We present a case of Lyme disease (LD) as a trigger of normocomplementemic UV, a very rarely described association. The patient presented first with episodes of inflammatory polyarthritis and a positive serology for Borrelia burgdorferi, later followed by the appearance of long-lasting urticarial lesions, histologically suggestive of UV. Lyme arthritis resolved with doxycycline, but UV persisted. Response to cyclosporine was satisfactory but with side effects, and only methotrexate showed substantial and consistent improvement. This case reminds physicians that chronic urticaria with atypical characteristics should raise suspicion of UV. Possible triggers for this disease must be sought, even if rarely described, such as LD. Normocomplementemic UV frequently presents a therapeutic challenge, but methotrexate can be a particularly effective therapy in this setting.
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Affiliation(s)
- Carolina Teles
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elsa Gaspar
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lèlita Santos
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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6
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Peñuelas Leal R, Labrandero Hoyos C, Partarrieu Mejías F, Grau Echevarría A, Lorca Spröhnle J, Casanova Esquembre A, Esteve Martínez A, Zaragoza Ninet V. Treatment-resistant systemic lupus erythematosus-associated hypocomplementic urticarial vasculitis successfully treated with belimumab. Australas J Dermatol 2023; 64:301-303. [PMID: 36745520 DOI: 10.1111/ajd.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
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7
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Bonnekoh H, Krause K, Kolkhir P. Chronic recurrent wheals - If not chronic spontaneous urticaria, what else? Allergol Select 2023; 7:8-16. [PMID: 36644011 DOI: 10.5414/ALX02375E] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 01/04/2023] Open
Abstract
Chronic urticarial rash, mostly due to chronic spontaneous urticaria (CSU), is seen in up to 1 - 4% of the general population. Urticarial vasculitis (UV) and autoinflammatory syndromes, i.e., cryopyrin-associated periodic syndromes (CAPS) and Schnitzler syndrome (SchS), can mimic CSU-like rash but represent rare disorders with systemic symptoms including fever, headache, conjunctivitis, and arthralgia. Clinical and laboratory features can point to the presence of any of these diseases in patients initially presenting with chronic urticarial rash. These include long-lasting wheals (> 24 hours), lesional burning, systemic symptoms, and/or increase in inflammatory markers (e.g., C-reactive protein, serum amyloid A, and/or S100A8/9). Lesional skin biopsy usually demonstrates leukocytoclastic vasculitis (UV) or neutrophil-rich infiltrate (CAPS and SchS). In contrast to CSU, where second-generation H1 antihistamines and omalizumab allow to control symptoms in most patients, systemic immunosuppression and anti-interleukin (IL)-1 therapies are needed in case of UV and autoinflammatory diseases, respectively. The rarity and low awareness of CSU differential diagnoses may be related to the longer delays in diagnosis and therapy in those affected with UV, CAPS, and SchS. Knowledge of the differential diagnoses of CSU is important because only correct diagnosis allows adequate therapy. Complications such as the development of lymphoproliferative disease in SchS and amyloidosis in CAPS, and the presence of comorbid diseases, such as systemic lupus erythematosus in UV, must be considered and monitored.
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8
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Makris M, Altrichter S, Ensina LF, Kocatürk E, Rudenko M. Editorial: The complexity of urticaria. Front Allergy 2023; 4:1149540. [PMID: 36873049 PMCID: PMC9982085 DOI: 10.3389/falgy.2023.1149540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.,Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany
| | - Sabine Altrichter
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany.,Department of Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | - Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Emek Kocatürk
- Institute for Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universitätzu Berlin, Berlin, Germany.,Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Michael Rudenko
- London Allergy and Immunology Centre, London, United Kingdom
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Corrà A, Verdelli A, Mariotti EB, Ruffo di Calabria V, Quintarelli L, Aimo C, Sunderkötter CH, Caproni M. Cutaneous vasculitis: Lessons from COVID-19 and COVID-19 vaccination. Front Med (Lausanne) 2022; 9:1013846. [PMID: 36569148 PMCID: PMC9780506 DOI: 10.3389/fmed.2022.1013846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
Cutaneous vasculitis (CV) is an inflammatory skin-limited vascular disease affecting the dermal and/or hypodermal vessel wall. From the pathogenetic point of view, idiopathic forms are described as well as the induction from various triggers, such as drugs, infections, and vaccines. Following SARS-CoV-2 pandemic outbreak, cases of CV induced by both COVID-19 and COVID-19 vaccinations have been reported in literature. The aim of our work was to collect multiple cases available in the literature and analyze the frequency of the different forms of induced vasculitis, as well as their histological and immunopathological features. Although rare, CV induced by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and vaccines may provide interesting insights into the pathogenesis of these inflammatory processes that may in the future be useful to understand the mechanisms underlying cutaneous and systemic vasculitis.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | | | | | - Lavinia Quintarelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cord H. Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy,*Correspondence: Marzia Caproni ;
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10
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Gosnell HL, Grider DJ. Urticarial vasculitis: A potential signpost for multisystem inflammatory syndrome in children. J Cutan Pathol 2021; 49:163-166. [PMID: 34523756 DOI: 10.1111/cup.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare and serious complication of Sars-Cov-2 infection. Dermatologic manifestations are present in the majority of patients. Skin lesions found in children with MIS-C are classified into four categories: morbilliform, reticulated, scarlatiniform, and urticarial lesions. Clinicopathologic characterization within these categories is limited. Thus, we present a clear example of an urticarial lesion in the context of MIS-C with well-documented clinicopathologic phenomena. A previously healthy 16-year-old female presented with 3 weeks of an itchy, burning rash initially presenting on her right forearm (and lasting greater than 24 hours without migration) before spreading diffusely. She also reported fever, cough, myalgias, nausea, and vomiting of 4 weeks' duration. Physical examination revealed an edematous, maculopapular, nonblanching, erythematous rash covering the patient's upper extremities, abdomen, back, anterior thighs, and face. The patient tested positive for COVID-19. A low-grade leukocytoclastic vasculitis was noted along with intraluminal fibrin and rare microthrombi in vessels of the mid to deep dermis. The patient was diagnosed with MIS-C and urticarial vasculitis. She was treated with steroids and naproxen for subsequent MIS-C flares. Dapsone treatment was started for the urticarial vasculitis.
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Affiliation(s)
- Hailey L Gosnell
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Douglas J Grider
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA.,Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, Virginia, USA
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11
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Nnomadim O, Speck H, Vidaurri D. Time After Time: A Second Look at Evolving Rash With Multiple Exposures to Amoxicillin. Cureus 2021; 13:e17807. [PMID: 34660017 PMCID: PMC8497804 DOI: 10.7759/cureus.17807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Pediatric penicillin drug reactions may present in many forms such as erythema multiforme, serum-sickness, serum-sickness-like reaction (SSLR), Henoch-Schonlein Purpura (HSP), and urticarial vasculitis. Here, we review the case of a 13-month-old with atypical presentation of a drug reaction with increasing severity after each exposure to amoxicillin. We discuss the various differential diagnoses in comparison to our patient's presentation and conclude with the recommendation of considering timing and previous exposures in the diagnosis of drug-associated rashes in pediatric population.
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Affiliation(s)
- Ozioma Nnomadim
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Heather Speck
- Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
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12
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Hope L, Hope B, Nguyen J, Hope R, Tarbox M. The COVID rash that puts the 'U' in GROUCH! Proc AMIA Symp 2021; 34:608-609. [PMID: 34456487 DOI: 10.1080/08998280.2021.1930850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
As COVID-19 continues, there are new manifestations and less common presentations of this illness of which we need to be aware. This case describes a 44-year-old woman with a new-onset rash on her lower back and inner thighs. Based on a punch biopsy of both locations, either severe urticaria or early urticarial vasculitis was diagnosed. The patient recovered after treatment with a combination of oral steroids and high-dose antihistamines. Two days after the biopsy, she tested positive for SARS-CoV-2. The urticarial vasculitic reaction was likely secondary to infection from COVID-19 and was the initial presentation of the disease.
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Affiliation(s)
- Landon Hope
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Brianna Hope
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jeannie Nguyen
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Richard Hope
- Lubbock Dermatology and Skin Cancer Center, Lubbock, Texas
| | - Michelle Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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13
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Shahidi Dadras M, Rakhshan A, Diab R, Abdollahimajd F. SARS-CoV-2 infection as a potential triggering factor for urticarial vasculitis during pregnancy: A case report. Clin Case Rep 2021; 9:e04323. [PMID: 34194805 PMCID: PMC8223884 DOI: 10.1002/ccr3.4323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
During the COVID-19 pandemic, physicians must maintain a high index of suspicion for COVID-19 in cases of urticarial vasculitis or other forms of urticaria. This is particularly important for acute presentations in otherwise asymptomatic individuals and pregnant women, where a prompt approach to the patient can prevent undesirable complications.
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Affiliation(s)
- Mohammad Shahidi Dadras
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Clinical Research Development UnitShohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Azadeh Rakhshan
- Clinical Research Development UnitShohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
- Department of PathologyShohada‐e Tajrish HospitalSchool of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Reem Diab
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Fahimeh Abdollahimajd
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Clinical Research Development UnitShohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
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14
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Batista M, Calado R, Gil F, Cardoso JC, Tellechea O, Gonçalo M. Histopathology of chronic spontaneous urticaria with occasional bruising lesions is not significantly different from urticaria with typical wheals. J Cutan Pathol 2021; 48:1020-1026. [PMID: 33595130 DOI: 10.1111/cup.13985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/31/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) may occasionally exhibit long-lasting lesions with bruising, usually considered a hallmark of urticarial vasculitis (UV). Histopathology of these chronic urticarial lesions has not been extensively studied. METHODS Skin biopsies from patients with anti-H1 resistant CSU were evaluated for several parameters (edema, location, intensity, and cell composition of the inflammatory infiltrate, and abnormalities in the blood vessels). RESULTS We studied 45 patients (37 female/8 male, mean age 49.3 years) with CSU, 60% of whom with occasional bruising lesions and 3 patients with hypocomplementemic UV. Histopathology in CSU showed mainly perivascular and interstitial inflammatory infiltrate (91.1%), including eosinophils (80%), neutrophils (77.8%), and lymphocytes (71.1%), vasodilatation (88.9%), intravascular neutrophils (95.6%), dermal edema (51.1%), swelling of endothelial cells (51.1%), and minor and rare fibrinoid necrosis and karyorrhexis (6.7%). Significant karyorrhexis and frank fibrinoid necrosis were observed, respectively, in two and three cases of UV. In patients with occasional bruising, mast cells occurred in fewer cases whereas eosinophils were more frequent, but no statistically significant difference was found for other parameters. CONCLUSIONS Histopathological findings were not significantly different between CSU with or without bruising lesions. Bruising may be associated with more severe forms of CSU with no histopathological signature, although UV cannot be completely excluded based on histopathology.
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Affiliation(s)
- Mariana Batista
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rebeca Calado
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Gil
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José C Cardoso
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Oscar Tellechea
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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15
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Al Musalhi BH, Al Kamzari A, Al Kindi F, Al Abrawi S, Al-Zakwani I, Abdwani R. Clinical spectrum of childhood-onset hypocomplementemic urticarial vasculitis in Oman: A retrospective multicenter study. J Am Acad Dermatol 2020; 85:1617-1620. [PMID: 33352266 DOI: 10.1016/j.jaad.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ahmed Al Kamzari
- Child Health Department, Oman Medical Specialty Board, Muscat, Oman
| | - Fatma Al Kindi
- Child Health Department, Oman Medical Specialty Board, Muscat, Oman
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman; Gulf Health Research, Muscat, Oman
| | - Reem Abdwani
- Child Health Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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16
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Alharbi S, Sanchez-Guerrero J. Successful Treatment of Urticarial Vasculitis in a Patient With Systemic Lupus Erythematosus With Rituximab. Clin Med Insights Arthritis Musculoskelet Disord 2020; 13:1179544120967374. [PMID: 33192108 PMCID: PMC7594233 DOI: 10.1177/1179544120967374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/22/2020] [Indexed: 11/15/2022]
Abstract
Urticarial vasculitis is an eruption of erythematous wheals that clinically resemble urticaria but histologically show changes of leukocytoklastic vasculitis. In association with connective tissue disease it is most commonly seen complicating Systemic lupus erythematous (SLE) and, less often, Sjogren's syndrome. Here, we report a 25-year-old woman who developed SLE in 1998. In May 2013 she presented with urticarial vasculitis; her skin biopsy was consistent with leukocytoclastic vasculitis. She also developed bilateral uveitis. She had most of the clinical and laboratory characteristics of hypocomplementic urticarial vasculitis syndrome (HUVS) which is difficult to be differentiated from SLE. She was treated with high-dose prednisone, Mycophenolate Mofetil (MMF), colchicine, and Dapsone but failed. We decided to give her Rituximab (RTX), her urticarial vasculitis and uveitis symptoms improved significantly. Unfortunately, later on she presented with severe discoid lupus. We started her on thalidomide and responded well. Our case highlights that Rituximab is a good option for severe refractory urticarial vasculitis and thalidomide is effective in treatment of discoid lupus erythematosus (DLE), and can be used safely in specialist rheumatological practice.
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Affiliation(s)
- Samar Alharbi
- Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Taibah University, Medina, Saudi Arabia
| | - Jorge Sanchez-Guerrero
- Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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17
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Serarslan G, Okyay E. Clinical characteristics and treatment outcomes in patients with urticarial vasculitis. North Clin Istanb 2021; 8:513-7. [PMID: 34909591 DOI: 10.14744/nci.2020.55476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/09/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Urticarial vasculitis (UV) is an uncommon disease clinically presenting with pruritic urticarial plaques of the skin. The disease is classified as normocomplementic and hypocomplementemic types according to their complement levels. We aimed to evaluate demographic characteristics, laboratory findings, and response to treatment of patients diagnosed as UV in our clinic. METHODS Between January 2015 and January 2019, the files of the patients were retrospectively reviewed. Demographic data, clinical features, laboratory findings, suspected triggering factors, disease course, treatment modalities, and treatment results of the patients were recorded. RESULTS A total of 16 patients (nine males [56.25%], seven females [43.75%]) were included in the study.The mean age at diagnosis was 45.2±10.4 years and the duration of the disease was 72.1±62 months. Twelve (75%) patients had angioedema and two (12.5%) patients had residual hyperpigmentation. The most common extracutaneous finding was arthralgia (43.7%). No hypocomplementemia was detected in the patients. The most common abnormal laboratory findings were CRP elevation (37.5%) and ANA positivity (n=4/15, 26.7%). Analgesic and antibiotic drugs use were the most common possible triggering factors for the disease (n=9, 56%). Oral antihistamines, oral corticosteroids, azathioprine, colchicine, dapsone, hydroxychloroquine, doxepin, and omalizumab were among the treatments given to the patients. Complete remission was achieved in three patients. CONCLUSION Compared with other studies, we found that angioedema was more frequent, postinflammatory hyperpigmentation was lower and long-term treatment was needed to control UV attacks. There are a few studies on UV and we think that more and larger patient groups are needed for standardization of treatment.
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18
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Liu E, Daze RP, Moon S. Tumid Lupus Erythematosus: A Rare and Distinctive Variant of Cutaneous Lupus Erythematosus Masquerading as Urticarial Vasculitis. Cureus 2020; 12:e8305. [PMID: 32607289 PMCID: PMC7320659 DOI: 10.7759/cureus.8305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 01/03/2023] Open
Abstract
Tumid lupus erythematosus (TLE) is a rare form of chronic cutaneous lupus that has triggered much debate regarding its clinical and histopathological features. It has been classically defined as annular erythematous, succulent, plaques involving the face and trunk that typically are devoid of any papulosquamous features such as scale and follicular plugging. These lesions are a clinical mimicker of other urticarial lesions such as urticarial vasculitis and lymphocytic infiltrate of Jessner. We report a case of TLE presenting in a 49-year-old Caucasian female whose initial clinical presentation was concerning for urticarial vasculitis due to presence of urticarial-like lesions present for approximately three months. Laboratory studies and histopathological correlations confirmed the diagnosis of TLE and the patient was successfully treated with topical corticosteroids.
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Affiliation(s)
- Evan Liu
- Dermatology, Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Largo, USA
| | | | - Summer Moon
- Dermatology, Largo Medical Center, Largo, USA
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19
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Kamrani P, Giesey R, Delost GR, Moore B. Recurrent painful ecchymosis in an adolescent female. JAAD Case Rep 2020; 6:30-32. [PMID: 31909134 PMCID: PMC6938817 DOI: 10.1016/j.jdcr.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Payvand Kamrani
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Rachel Giesey
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gregory R Delost
- Apex Dermatology and Skin Surgery Center, Mayfield Heights, Ohio
| | - Brian Moore
- Apex Dermatology and Skin Surgery Center, Mayfield Heights, Ohio
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20
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Velasco-Tamariz V, Prieto-Barrios M, Tous-Romero F, Palencia-Pérez SI, Postigo-Llorente C. Urticarial vasculitis after meningococcal serogroup B vaccine in a 6-year-old girl. Pediatr Dermatol 2018; 35:e64-e65. [PMID: 29164681 DOI: 10.1111/pde.13339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The first vaccine that shows significant potential in providing broad coverage against serogroup B meningococcal disease has recently been approved. Because of its newness, potential adverse events need to be reported. Here we report a case of urticarial vasculitis, a rare disease in children, in probable relationship with the novel vaccine.
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21
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Keyla Chan Y, Criado RFJ, Criado PR, Machado CDAS, Speyer C. Urticarial vasculitis in the childhood with C2 hypocomplementenemia: a rare case. Eur Ann Allergy Clin Immunol 2016; 48:247-250. [PMID: 27852431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report a first case of hypocomplementemic urticarial vasculitis of C2 fraction in a child, with cutaneous manifestation only, with no reports in scientific literature.
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Affiliation(s)
- Y Keyla Chan
- Facultade de Medicina do ABC (FMABC), Santo André (SP), Brazil. E-mail:
| | - R F J Criado
- Facultade de Medicina do ABC (FMABC), Santo André (SP), Brazil
| | - P R Criado
- Universidade de Sào Paulo (USP), São Paulo, Brazil
| | - C D A S Machado
- Facultade de Medicina do ABC (FMABC), Santo André (SP), Brazil
| | - C Speyer
- Facultade de Medicina do ABC (FMABC), Santo André (SP), Brazil
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22
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Arora A, Wetter DA, Gonzalez-Santiago TM, Davis MDP, Lohse CM. Incidence of leukocytoclastic vasculitis, 1996 to 2010: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 2014; 89:1515-24. [PMID: 24981218 PMCID: PMC4252802 DOI: 10.1016/j.mayocp.2014.04.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/04/2014] [Accepted: 04/17/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the population-based incidence of leukocytoclastic vasculitis (LCV). PATIENTS AND METHODS This is a retrospective population-based study of all Olmsted County, Minnesota, residents with a skin biopsy-proven diagnosis of LCV from January 1, 1996, through December 31, 2010. RESULTS A total of 84 patients (mean age at diagnosis, 48.3 years) with newly diagnosed skin biopsy-proven LCV (43 women and 41 men) were identified. The incidence rate (age and sex adjusted to the 2000 US white population) was 4.5 per 100,000 person-years (95% CI, 3.5-5.4). The incidence of LCV increased significantly with age at diagnosis (P<.001) and did not differ between female and male patients. Subtypes of LCV were cutaneous small-vessel vasculitis (CSVV), 38 patients (45%); IgA vasculitis, 25 (30%); urticarial vasculitis, 10 (12%); cryoglobulinemic vasculitis, 3 (4%); and antineutrophil cytoplasmic antibody-associated vasculitis, 8 (10%). LCV was idiopathic in 29 of 38 patients with CSVV (76%) and 24 of 25 patients with IgA vasculitis (96%). Thirty-nine of 84 patients (46%) had systemic involvement, with the renal system most commonly involved (17 of 39 [44%]). Twenty-four of 80 patients (30%) with follow-up data available had recurrent disease. Compared with the Minnesota white population, observed survival in the incident LCV cohort was significantly poorer than expected (P<.001), including the subset of patients with idiopathic CSVV (P=.03). CONCLUSION The incidence of LCV was higher than that reported in previously published studies. Idiopathic LCV was more common in our population-based cohort than that described previously. Overall survival was significantly poorer (P<.001) and should be explored further in future studies.
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Affiliation(s)
- Amrita Arora
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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23
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Bock VL, Friedlander M, Waring D, Kossard S, Wood GK. Cutaneous adverse effects of hormonal adjuvant therapy for breast cancer: a case of localised urticarial vasculitis following anastrozole therapy and a review of the literature. Australas J Dermatol 2014; 55:282-5. [PMID: 24575835 DOI: 10.1111/ajd.12110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
Hormonal therapy with either tamoxifen or aromatase inhibitors is commonly used to treat women with breast cancer in both the adjuvant and recurrent disease setting. Cutaneous adverse reactions to these drugs have been rarely reported in the literature. We report an unusual case of urticarial vasculitis following the aromatase inhibitor anastrozole that localised to the unilateral trunk and mastectomy scar, and review the literature on the cutaneous adverse effects of hormonal therapy for breast cancer.
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Affiliation(s)
- Vanessa L Bock
- Brien Walder Department of Dermatology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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24
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Li M, Chen T, Guo Z, Li J, Cao N. Tumor necrosis factor-like weak inducer of apoptosis and its receptor fibroblast growth factor-inducible 14 are expressed in urticarial vasculitis. J Dermatol 2013; 40:891-5. [PMID: 23968277 DOI: 10.1111/1346-8138.12251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/27/2013] [Indexed: 02/05/2023]
Abstract
Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK), a member of the TNF family, has been implicated as a pro-inflammatory cytokine in many types of autoimmune and infectious diseases. However, information about TWEAK in dermatological diseases is limited. To date, no studies have investigated the roles of TWEAK in patients with urticarial vasculitis (UV). This study aimed to assess serum TWEAK levels, together with TWEAK and fibroblast growth factor-inducible 14 (Fn14) expressions of skin lesions in patients with UV. Serum TWEAK levels in patients with UV, together with patients with cutaneous leukocytoclastic angiitis (CLA) and healthy controls were detected by enzyme-linked immunosorbent assay; TWEAK and Fn14 expressions of skin lesions were analyzed by immunohistochemistry. Results showed that TWEAK and Fn14 were abundantly expressed in the dermal vessel wall of lesional skin in patients with UV but not healthy controls. Serum TWEAK levels in the acute stage in patients with UV were significantly higher than those in the convalescent stage and healthy controls. Serum TWEAK levels were elevated significantly in patients with CLA compared with those in healthy controls. Our previous study indicated that TWEAK may be an important mediator for the development of vascular inflammation in skin. In addition, we also found that TWEAK blockade substantially reduced vascular damage and perivascular leukocyte infiltrates in lipopolysaccharide-induced cutaneous vasculitis. Our study shows that TWEAK may be associated with the pathogenesis of UV; it is therefore suggested that TWEAK may be a potential therapeutic target for UV and other types of cutaneous vasculitis.
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Affiliation(s)
- Mengmeng Li
- Department of Dermatovenereology, West China Hospital of Sichuan University, Chengdu, China
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25
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Kartal O, Gulec M, Caliskaner Z, Nevruz O, Cetin T, Sener O. Plasmapheresis in a patient with "refractory" urticarial vasculitis. Allergy Asthma Immunol Res 2012; 4:245-7. [PMID: 22754719 PMCID: PMC3378932 DOI: 10.4168/aair.2012.4.4.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/21/2011] [Accepted: 12/15/2011] [Indexed: 12/02/2022]
Abstract
Immune complexes are found in the circulation of 30%-75% of patients with urticarial vasculitis and much evidence supports the role of these immune complexes in the pathogenesis of urticarial vasculitis. Plasmapheresis is effective for removing these immune complexes; however, there are few reports on the use of plasmapheresis in the treatment of urticarial vasculitis. We describe a case of "refractory" urticarial vasculitis in which the symptoms improved after plasmapheresis treatment. We suggest that plasmapheresis be considered as an option in patients with severe or treatment-resistant urticarial vasculitis.
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Affiliation(s)
- Ozgur Kartal
- Division of Immunology and Allergic Diseases, Gülhane Military Medical Academy and Medical School, Ankara, Turkey
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26
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Ashida A, Murata H, Ohashi A, Ogawa E, Uhara H, Okuyama R. A case of hypocomplementaemic urticarial vasculitis with a high serum level of rheumatoid factor. Australas J Dermatol 2012; 54:e62-3. [PMID: 23905981 DOI: 10.1111/j.1440-0960.2011.00873.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a case of hypocomplementaemic urticarial vasculitis with an elevated serum rheumatoid factor level. Hypocomplementaemic urticarial vasculitis is an immune complex-mediated disease characterised by urticarial eruptions. High levels of rheumatoid factor may be associated with hypocomplementaemia due to the consumption of complement, because the rheumatoid factor can form immune complexes with immunoglobulin. It is necessary to pay attention to the amounts of complement in cases of urticarial eruptions with elevated rheumatoid factor level. The eruptions were relieved with a combination of prednisolone and colchicine.
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Affiliation(s)
- Atsuko Ashida
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
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27
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Abstract
Patients with urticaria make up a large proportion of the referrals to allergy clinics. There are many causes of urticaria and it is the clinical history which is most important when attempting to identify potential causes; however, urticaria is very often idiopathic. In a small minority of patients urticaria may be a symptom of a serious underlying medical illness or the allergic symptoms may progress to cause systemic reactions, and it is important to identify these patients and to remember that severe urticaria is a distressing and disabling condition. This review will discuss classification, investigation and treatment of urticaria and will consider some of the more unusual types of urticaria that may be encountered in the out-patient clinic.
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Affiliation(s)
- S J Deacock
- Royal Surrey County Hospital NHS Trust, Guildford, Surrey, UK.
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