Mere information ― Dansk

Urticarial vasculitis er en sjælden tilstand præget af langvarige eller tilbagevendende episoder med nældefeber. Selvom hudsymptomerne kan ligne kronisk nældefeber, er de karakteristiske, fordi udslættet varer mindst 24 timer og kan efterlade mørke pletter, når det falmer. Årsagen er ofte ukendt, men tilstanden kan udløses af visse medikamenter, infektioner, autoimmune sygdomme, blodsygdomme eller kræft. Nogle undersøgelser har endda forbundet den med COVID‑19 og H1N1‑influenza. Den kan også påvirke andre organer såsom muskler, nyrer, lunger, mave og øjne. En specifik vævsundersøgelse kan bekræfte diagnosen, men den er ikke altid nødvendig. Behandlingen starter typisk med antibiotika, dapson, colchicin eller hydroxychloroquin i milde tilfælde. Ved sværere forløb kan immundæmpende lægemidler som methotrexat eller kortikosteroider være nødvendige. På det seneste har biologiske terapier (rituximab, omalizumab, interleukin‑1‑inhibitorer) vist lovende resultater i 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 knalrøde, smertefulde udslæt på både lår og ben samt ledsmerter. Han havde haft en urinvejsinfektion i en uge, før udslættet optrådte. På huden var der flere ømme, ringformede, delvist blancherbare, røde plaques på begge lår og ben. Han fik oral prednisolon (40 mg/dag) i en uge sammen med en ikke‑døsig antihistamin (fexofenadine). Inden for en uge forsvandt alle udslæt fuldstændigt. Der var ingen nye udslæt i løbet af de næste seks 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.