Difficulties of hypocomplementemic urticaria vasculitis diagnostics

Abstract

Urticaria vasculitis is a multisystem disease with cutaneous lesions which resemble urticaria and histologic signs of leukocytoclastic vasculitis. The article highlights the main aspects of etiology, pathogenesis, clinical and histopathological disease manifestations, and also methods of treatment. Difficulties of a diagnostic process are demonstrated by means of an example of our own follow-up of a patient with Urticaria vasculitis having a history of solar urticaria. The main trigger of episodes relapse of urticarial rash in the form of coldinduced urticaria and urticaria resulting from blood pressure, was a stress factor and hemorrhage from the duodenal bulb ulcer. The analysis of clinical data and peculiarities of disease progression was conducted for the purpose of diff erential diagnostic procedure of urticaria and urticaria vasculitis. The patient’s urticaria lasted longer than 24 hours; haemosideric staining was observed in the course of rash resolving, local oedemata resembling Quincke’s edema ailed, general symptoms were present (arthralgia, fever, abdominal pains, neurological disorders, etc.). Low effi ciency of antihistamines was reported. Laboratory examination revealed the increase in the blood sedimentation rate, lowering of the complement component 3, raise of anti-C1q and cryoglobulinemia. The essential component of the diagnostic search was biopsy of the skin which allowed to reveal signs of leukocytoclastic vasculitis. On the basis of the clinical evidence (fixed urticarial eruption), laboratory data (hypocomplementemia), histological examination of skin (leukocytoclastic vasculitis) and multisystemic pathology found (of joints, heart, GIT, nervous system), the patient has been diagnosed with a hypocomplementary urticaria vasculitis. Moreover, the article includes recommendations on sampling of pathological material due to primary importance of skin biopsy results in diagnostics of the urticarial vasculitis. Medical professionals no matter of their speciality, should know peculiarities of Urticaria vasculitis progression to reduce the likelihood of its error diagnosis as recurrent urticaria or other immunological disease.