Is chronic urticaria or urticarial vasculitis a diagnostic dilemma?
DOI:
https://doi.org/10.15574/SP.2024.138.133Keywords:
urticaria, vasculitis, autoantibodies, childrenAbstract
Introduction. Urticarial vasculitis (UV) is a rare disease that has two components: clinical manifestations of urticaria and histopathological signs of cutaneous leukocytoclastic vasculitis of small vessels, predominantly involving postcapillary venules. This condition is characterized by chronic or recurrent episodes of urticaria, each element of which lasts more than 24 hours and is accompanied by a feeling of pain and burning.
The aim is to reveal the key points of pathogenetic mechanisms, differential diagnosis and therapeutic tactics of UV based on a clinical case.
Clinical case. A clinical case of a 17-year-old boy with normocomplementemic UV is described. The patient's main complaint was a long-lasting rash (more than three weeks) with itching. From the anamnesis it is known that the provoking factors for the onset of the disease were an insect bite and the start of taking a new drug, namely vitamin K (two days before the onset of the disease). Throughout this time, the child was examined by various specialists and received treatment. Alternative diagnoses: bacterial folliculitis, viral exanthem, unspecified urticaria. There was no positive effect from the received treatment. The diagnosis of UV was made in the sixth week of the disease using a punch biopsy. Regression of the skin syndrome was achieved using a combination of antihistamine and antileukotriene drugs.
Conclusions. Performing a punch biopsy, which is currently the gold standard for diagnosis, allows us to solve the diagnostic dilemma: “UV or chronic urticaria”. Timely diagnosis helps to avoid false diagnoses and, as a result, incorrect treatment of UV. The description of this clinical case is a contribution to the disclosure of this globally complex problem.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the child and child's parents was obtained for conducting the research.
No conflict of interest was declared by the authors.
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