1/93. urticaria from trichomonas vaginalis infection.We report the case of a 32-year-old woman who had pruritic urticarial skin lesions associated with episodes of arthralgia. The first site affected by the eruption was the inside surface of the thighs; the patient also reported the presence of leukorrhea. The woman had previously been treated with H1 antagonist with moderate and transitory results; skin lesions reappeared just after the interruption of the treatment. Her biochemical data showed increased levels of erythrocyte sedimentation rate, blood eosinophilia and hypocomplementemia. Antinuclear antibodies, rheumatoid factor, cryoglobulins and serological diagnosis for hepatitis or mononucleosis viruses resulted negative. Considering the initial site of the cutaneous features and the presence of leukorrhea, we requested a vaginal smear and a culture of the cervical secretion, which revealed the presence of a Trichomonas infection. Furthermore, the SDS-PAGE revealed the presence of a molecular mass of 230,000 Da (230-kDa) in the serum, which indicated a Trichomonas surface protein. The following treatment with oral metronidazole caused the eradication of the Trichomonas infection after 3 weeks and subsequently the resolution of the urticarial clinical features. We wish to underline that in the presence of a case of urticaria vasculitis syndrome which seems to be without cause, it is important to investigate every diagnostic suspicion scrupulously.- - - - - - - - - - ranking = 1keywords = vasculitis (Clic here for more details about this article) |
2/93. Dermatological adverse effects with the antimalarial drug mefloquine: a review of 74 published case reports.mefloquine is a relatively new antimalarial drug which has been associated with a wide variety of adverse effects, including skin reactions. In order to evaluate the range and frequency of mefloquine's dermatological effects, we searched the scientific literature for published case reports of such effects. We found 74 case reports, published between the years 1983 and 1997. pruritus and maculopapular rash are the dermatological effects most commonly associated with mefloquine: their approximate frequency is 4-10% for pruritus, and up to 30% for nonspecific maculopapular rash. Adverse effects associated less commonly with mefloquine include urticaria, facial lesions and cutaneous vasculitis. One case of stevens-johnson syndrome and one fatal case of toxic epidermal necrolysis occurred. Appropriate primary studies of mefloquine use should be carried out to elucidate the epidemiology and aetiology of dermatological and other adverse effects of the drug.- - - - - - - - - - ranking = 1keywords = vasculitis (Clic here for more details about this article) |
3/93. Hypocomplementemic urticarial vasculitis: report of a pediatric case.Hypocomplementemic urticarial vasculitis syndrome (HUVS) is well described in adults but is quite rare in children. We report a pediatric case of HUVS initially diagnosed as juvenile rheumatoid arthritis and then as Henoch-Schonlein purpura. Beginning at 3 years of age, our patient developed polyarthritis with hypocomplementemia. She subsequently experienced an intermittent purpuric rash beginning at age 4 years, and she continued to have episodic arthritis and rash for years. hematuria and proteinuria were noted at 12 years of age; renal biopsy revealed membranoproliferative glomerulonephritis with membranous features. serum complement evaluation revealed activation of the classical pathway, consistent with HUVS. Therapy with oral dapsone led to improvement in proteinuria. HUVS should be considered in the differential diagnosis of pediatric patients with glomerulonephritis, urticarial rash, arthritis/arthralgias, and obstructive pulmonary disease.- - - - - - - - - - ranking = 5keywords = vasculitis (Clic here for more details about this article) |
4/93. Crescentic glomerulonephritis complicating the course of a hypocomplementemic urticarial vasculitis.The authors report a case of crescentic glomerulonephritis leading to end-stage renal failure in a patient affected by a hypocomplementemic urticarial vasculitis (HUV). The patient's clinical course was characterized by the survey of several episodes of extra-renal vasculitis. We emphasize that HUV commonly considered as a limited form of vasculitis might in some cases have a dramatic evolution.- - - - - - - - - - ranking = 7keywords = vasculitis (Clic here for more details about this article) |
5/93. Renal transplantation in a patient with hypocomplementemic urticarial vasculitis syndrome.We describe a 36-year-old man who presented with hypocomplementemic urticarial vasculitis syndrome (HUVS) with severe renal involvement. Despite steroid therapy, the patient developed end-stage renal disease (ESRD) leading to chronic hemodialysis therapy. Renal transplantation was performed after hemodialysis therapy (secondary), and the patient developed a typical HUVS relapse 9 months after transplantation despite conventional immunosuppressive therapy that was successfully treated with plasma exchange. This case shows for the first time that HUVS can induce severe renal involvement responsible for ESRD and that HUVS can relapse after renal transplantation. It also suggests that plasma exchange therapy may be of value for rapidly controlling the clinical symptoms.- - - - - - - - - - ranking = 5keywords = vasculitis (Clic here for more details about this article) |
6/93. The schnitzler syndrome. Four new cases and review of the literature.The schnitzler syndrome is characterized by a chronic urticarial eruption with a monoclonal IgM gammopathy. The other signs of the syndrome include intermittent elevated fever, joint and/or bone pain with radiologic evidence of osteosclerosis, palpable lymph nodes, enlarged liver and/or spleen, elevated erythrocyte sedimentation rate, and leukocytosis. The mean delay to diagnosis is more than 5 years, and this syndrome is of concern to internists and many medical specialists. patients with this syndrome are often initially considered to have lymphoma or adult-onset Still disease, which are the main differential diagnoses. However, hypocomplementic urticarial vasculitis, systemic lupus erythematosus, cryoglobulinemia, acquired C1 inhibitor deficiency, hyper IgD syndrome, chronic infantile neurologic cutaneous and articular (CINCA) syndrome, and Muckle-Wells syndrome should also be excluded, because diagnosis relies on a combination of clinical and biologic signs and there is no specific marker of the disease. The disease pursues a chronic course, and no remissions have yet been reported. Disabling skin rash, fever, and musculoskeletal involvement are the most frequent complications. Severe anemia of chronic disease is another serious complication. The most harmful complication, however, is evolution to an authentic lymphoplasmacytic malignancy, which occurs in at least 15% of patients. This hematologic transformation can occur more than 20 years after the first signs of the disease, thus patients deserve long-term follow-up. Treatment is symptomatic and unsatisfactory. The skin rash is unresponsive to treatment, and nonsteroidal antiinflammatory drugs, antihistamines, dapsone, colchicine, and psoralens and ultraviolet A (PUVA) therapy give inconstant results. fever, arthralgia, and bone pain often respond to nonsteroidal antiinflammatory drugs. In some patients, these symptoms and/or the presence of severe inflammatory anemia require steroids and/or immunosuppressive treatment, which ameliorate inflammatory symptoms but do not change the course of the skin rash.- - - - - - - - - - ranking = 1keywords = vasculitis (Clic here for more details about this article) |
7/93. Hypocomplementemic urticarial vasculitis, jaccoud's arthropathy, valvular heart disease, and reversible tracheal stenosis: a surfeit of syndromes.We describe a patient who, during 29 years of observation, manifested polyarthralgia and polyarthritis leading to progressive deformity of the joints of hands and feet (without loss of cartilage or erosion of bone); persistent urticaria made worse by cold and accompanied by hypocomplementemia; and progressive cardiac valvular disease with mitral and aortic stenosis and regurgitation. In 1996, she developed subglottic tracheal stenosis that resolved by the end of 1997 without a change in treatment, which has consisted of low dose azathioprine, glucocorticoid, and nonsteroidal antiinflammatory drugs. Tests for cryoprecipitable protein, antineutrophil cytoplasmic antibodies, antinuclear antibody, and rheumatoid factor were negative. skin biopsy was consistent with "leukocytoclastic vasculitis." The pathogenesis of this remarkable combination of syndromes is unknown.- - - - - - - - - - ranking = 5keywords = vasculitis (Clic here for more details about this article) |
8/93. Hypocomplementemic urticarial vasculitis and lower cranial nerve palsies.A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.- - - - - - - - - - ranking = 6keywords = vasculitis (Clic here for more details about this article) |
9/93. Membranoproliferative glomerulonephritis associated with hypocomplementemic urticarial vasculitis after complete remission of membranous nephropathy.A 49-year-old-man developed proteinuria in 1978. He was diagnosed as having membranous nephropathy by renal biopsy and was treated with prednisolone. The proteinuria disappeared completely and the treatment was stopped. In 1995, after complete remission, he developed nephrotic syndrome with chronic urticaria and hypocomplementemia. Renal biopsy revealed membranoproliferative glomerulonephritis (type I) and skin biopsy showed leukocytoclastic vasculitis, which was compatible with hypocomplementemic vasculitis syndrome. Steroid therapy was very effective.- - - - - - - - - - ranking = 6keywords = vasculitis (Clic here for more details about this article) |
10/93. Persistent urticaria--urticarial reaction caused by late phase reaction?In ordinary urticaria, individual lesions disappear within 24 hours. We encountered 3 patients who showed urticarial reactions lasting more than 24 hours. In all patients, skin biopsy revealed interstitial dermal edema and a perivascular infiltration predominated by eosinophils, without immunoglobulins or complement deposition, or endothelial fibrinoid degeneration. Their eosinophil counts and serum complement levels were within normal range. No proteinurea or joint pain was observed. They could not be controlled by any medications except for glucocorticoid. These findings indicate our cases are not ordinary urticaria, urticarial reaction accompanied by eosinophilia, urticarial vasculitis or delayed pressure urticaria. We recognize such urticarial reaction as a different clinical entity from the usual urticaria, and we speculate that this condition is caused by late phase reaction because of the clinical course and eosinophil infiltrations.- - - - - - - - - - ranking = 1keywords = vasculitis (Clic here for more details about this article) |
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