Mere information ― Dansk

Urticarial vasculitis er en sjælden tilstand præget af langvarige eller tilbagevendende episoder med nældefeber. Selvom dens hudsymptomer kan ligne kroniske nældefeber, er de unikke, fordi nældefeberne hænger ved i mindst 24 timer og kan forårsage mørke pletter efter falmning. Selvom det ofte er af ukendt årsag, kan det nogle gange udløses af visse medikamenter, infektioner, autoimmune sygdomme, blodsygdomme eller kræftformer. Nogle undersøgelser har endda forbundet det med COVID-19 og H1N1 influenza. Det kan også påvirke andre dele af kroppen som muskler, nyrer, lunger, mave og øjne. Mens en bestemt type vævsundersøgelse kan bekræfte diagnosen, er det ikke altid nødvendigt. Behandling starter typisk med antibiotika, dapson, colchicin eller hydroxychloroquin i mildere tilfælde. For mere alvorlige tilfælde kan lægemidler, der undertrykker immunsystemet, såsom methotrexat eller kortikosteroider, være nødvendige. For nylig har biologiske terapier (rituximab, omalizumab, interleukin-1 inhibitors) vist lovende for svære tilfælde.
Urticarial vasculitis is a rare clinicopathologic entity that is characterized by chronic or recurrent episodes of urticarial lesions. Skin findings of this disease can be difficult to distinguish visually from those of chronic idiopathic urticaria but are unique in that individual lesions persist for ≥24 hours and can leave behind dusky hyperpigmentation. This disease is most often idiopathic but has been linked to certain drugs, infections, autoimmune connective disease, myelodysplastic disorders, and malignancies. More recently, some authors have reported associations between urticarial vasculitis and COVID-19, as well as influenza A/H1N1 infection. Urticarial vasculitis can extend systemically as well, most often affecting the musculoskeletal, renal, pulmonary, gastrointestinal, and ocular systems. Features of leukocytoclastic vasculitis seen on histopathologic examination are diagnostic of this disease, but not always seen. In practice, antibiotics, dapsone, colchicine, and hydroxychloroquine are popular first-line therapies, especially for mild cutaneous disease. In more severe cases, immunosuppressives, including methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine, as well as corticosteroids, may be necessary for control. More recently, select biologic therapies, including rituximab, omalizumab, and interleukin-1 inhibitors have shown promise for the treatment of recalcitrant or refractory cases.

En 35-årig mand kom ind med en 15-dages historie med knaldrøde, smertefulde udslæt på både lår og ben sammen med ledsmerter. Han havde en urinvejsinfektion i en uge, før udslættet viste sig. Hans hud viste flere ømme, ringformede, delvist blancherbare, røde plaques på begge sider af hans lår og ben. Han fik oral prednisolon (40 mg/dag) i en uge sammen med en ikke-døsig antihistamin (fexofenadin) . Inden for en uge forsvandt alle udslæt fuldstændigt. Der var ikke flere udslæt i løbet af de næste 6 måneders regelmæssige kontroller.
A 35-year-old man came in with a 15-day history of bright red, painful rashes on both thighs and legs, along with joint pain. He had a urinary tract infection for a week before the rash appeared. His skin showed several tender, ring-shaped, partially blanchable, red plaques on both sides of his thighs and legs. He was given oral prednisolone (40mg/day) for a week along with a non-drowsy antihistamine (fexofenadine). Within a week, all the rashes disappeared completely. There were no more rashes during the next 6 months of regular check-ups.