Urticarial vasculitis in patients with chronic hepatitis C virus as an interdisciplinary problem

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Urticarial vasculitis is a skin disease characterized by recurrent urticarial lesions and histological features of leukocytoclastic vasculitis. Urticarial vasculitis is known to occur in the association with various infectious diseases, including chronic hepatitis C virus. However, the clinical features of urticarial vasculitis associated with hepatitis C virus have not been systematically characterized, which complicates the management of these patients. This review presents an analysis of published clinical, histological and laboratory findings in patients with urticarial vasculitis in the association with chronic hepatitis C virus, which can be helpful for early diagnosis and optimization of the patient management. We performed a Pubmed search to identify clinical cases from 1971 to 2022 using the keywords "urticarial vasculitis", "hepatitis C virus infection". According to the inclusion/exclusion criteria, 13 clinical cases of urticarial vasculitis associated with hepatitis C virus were included in the analysis. Clinical manifestations were urticarial rashes (n=13), associated with residual hyperpigmentation in 8 patients, tenderness/burning ― in 7 patients, and a lesion duration (24 hours) ― in five patients. Arthralgias were described in 3 patients. On histological examination, there were fibrinoid necrosis (n=2); leukocytoclasia (n=4); erythrocyte extravasation (n=1); dermis edema (n=2); perivascular infiltrate consisting of neutrophils (n=5), eosinophils (n=4), lymphocytes (n=3), and histiocytes (n=2). Hypocomplementemia was reported in eight patients. The laboratory work revealed cryoglobulinemia (n=9) and positive rheumatoid factor (n=6), which were the characteristic findings in the association of these diseases. The association of urticarial vasculitis and chronic hepatitis C virus is an important interdisciplinary problem that requires an interaction of dermatologists, allergists, hepatologists, rheumatologists and infectious disease doctors. Histological examination is indicated to differentiate between urticaria and urticarial vasculitis in patients with atypical urticarial lesions. Early detection of chronic hepatitis C virus is necessary for the timely administration of antiviral therapy. The urticarial vasculitis treatment should be selected taking into account their efficacy and the risk of hepatotoxicity.