Chronic spontaneous urticaria or urticarial vasculitis?

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Abstract

Chronic spontaneous urticaria is the spontaneous appearance of blisters, angioedema, or both for >6 weeks that affects up to 0.5%–5% of the population, mainly females. Spontaneous wheals and/or angioedema, severe skin itching that leads to depression and anxiety, sleep disturbances, sexual dysfunction, and activity of daily life and work restrictions. Other diseases sometimes occur under the guise of chronic spontaneous urticaria.

Urticarial vasculitis is a vasculitis of the small skin vessels, characterized by the duration of persistent skin rashes in combination with histopathological features of leukocytoclastic vasculitis. Differential diagnosis of chronic spontaneous urticaria and urticarial vasculitis is conducted in the case of an atypical clinical picture of urticaria. Wheals lasted for >24 h, often accompanied by burning and pain, and leaving behind purpura or residual hyperpigmentation.

Herein, described a case of urticarial vasculitis in a patient that required a differential diagnosis of chronic spontaneous urticaria and urticarial vasculitis several years after the disease onset. Successful treatment was conducted with a combination of antihistamines, glucocorticosteroids, hydroxychloroquine, and omalizumab.

About the authors

Irina V. Dorofeeva

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Email: idorofeeva1@gmail.com
ORCID iD: 0000-0002-4423-1797
SPIN-code: 5480-4193
Russian Federation, 24, Kashirskoyw shosse, Moscow, 115522

Inna V. Danilycheva

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Email: ivdanilycheva@mail.ru
ORCID iD: 0000-0002-8279-2173
SPIN-code: 4547-3948

MD, Cand. Sci. (Med.)

Russian Federation, 24, Kashirskoyw shosse, Moscow, 115522

Andrey E. Shuljenko

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Author for correspondence.
Email: shulzhenko_ae@mail.ru
ORCID iD: 0000-0003-0268-9350
SPIN-code: 4584-4915

MD, Dr. Sci. (Med.), Professor

Russian Federation, 24, Kashirskoyw shosse, Moscow, 115522

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2. Fig. Stained skin biopsy section. The epidermis is of normal thickness, its layers are differentiated, weak loose keratosis. The walls of the vessels of the papillary and reticular layers of the dermis are thickened due to edema and swelling of endothelial cells. Around the vessels there is weak infiltration from histiocytes, lymphocytes, eosinophilic granulocytes. In places, single eosinophilic leukocytes penetrate the vascular wall. The number of eosinophils is from 7 to 12 in the field of view with a magnification of 400 times. The changes correspond to urticarial vasculitis.

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