Estudio descriptivo de urticaria vasculítica en Medellín, Colombia: características clínicas, epidemiológicas y de laboratorio
Palabras clave:
urticaria, vasculitis, epidemiología
Resumen
Objetivo. Estudiar las características clínicas y de laboratorio de los pacientes con urticaria vasculítica, atendidos en el hospital Pablo Tobón Uribe, Clínica Universitaria Bolivariana y la IPS Universitaria en el periodo comprendido entre el año 2006 y el 2012.
Materiales y métodos. Se llevó a cabo un estudio observacional, descriptivo, retrospectivo y prospectivo de pacientes evaluados en el Hospital Pablo Tobón Uribe, Clínica Universitaria Bolivariana y la IPS Universitaria de Medellín.
Resultados. Ingresaron al estudio 24 pacientes, de los cuales, 20 eran mujeres (83,3 %); la edad media de inicio de las lesiones fue de 41,8 años. El 79 % tenía un valor normal de C3, y 70,8 % tenía C4 normal. Se indagaron síntomas asociados a los habones y se encontró dolor en 20,8 % y ardor en 29,2 %, y 50 % eran asintomáticos. En los pacientes evaluados se encontraron con mayor frecuencia artralgias, rinitis, artritis y dermatitis atópica. Entre los tratamientos más empleados se encontraron la dapsona, la colchicina, los esteroides y los antihistamínicos.
Conclusiones. En este estudio se presentan datos de los aspectos demográficos, clínicos y de laboratorio de los pacientes con urticaria vasculítica en nuestro medio, lo cual nos permite comparar nuestros resultados con otras series a nivel mundial.
Citas
1. Tosoni C, Lodi-Rizzini F, Cinquini M, Pasolini G, Venturini M, Sinico RA, et al. A reassessment of diagnostic criteria and treatment of idiopathic urticarial vasculitis: A retrospective study of 47 patients. Clin Exp Dermatol. 2008;34:166-70.
2. Aydogan K, Karadogan SK, Adim SB, Tunali S. Hypocomplementemic urticarial vasculitis: A rare presentation of systemic lupus erythematosus. Int J Dermatol. 2006,45:1057-61.
3. O’Loughlin S, Schroeter AL, Jordon RE. Chronic urticaria-like lesions in systemic lupus erythematosus: A review of 12 cases. Arch Dermatol. 1978;114:879-83.
4. Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: A histopathologic and clinical review of 72 cases. J Am Acad Dermatol. 1992;26:441-8.
5. Buhner D, Grant JA. Serum sickness. Dermatol Clin. 1985;3:107-17.
6. Kano Y, Orihara M, Shiohara T. Cellular and molecular dynamics in exercise-induced urticarial vasculitis lesions. Arch Dermatol. 1998;134:62-7.
7. Athanasiadis GI, Pfab F, Kollmar A, Ring J, Ollert M. Urticarial vasculitis with a positive autologous serum skin test: Diagnosis and successful therapy. Allergy. 2006;61:1484-5.
8. Bakos N, Hillander M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol. 2003;42:613-5.
9. Greaves MW. Chronic idiopathic urticaria and Helicobacter pylori –not directly causative but could there be a link? ACI International. 2001;13:23- 6.
10. Napoli DC, Freeman TM. Autoimmunity in chronic urticaria and urticarial vasculitis. Curr Allergy Asthma Rep. 2001;1:329-36.
11. Callen JP. Cutaneous vasculitis and other neutrophilic dermatoses. Curr Opin Rheumatol. 1993;5:33-40.
12. Wisnieski J. Urticarial vasculitis. Curr Opin Rheumatol. 2000;12:24-31.
13. Wisnieski JJ, Baer AN, Christensen J, Cupps TR, Flag DN, Jones JV, et al. Hypocomplementemic urticarial vasculitis syndrome: Clinical and serologic findings in 18 patients. Medicine. 1995;74:24-41.
14. Black AK. Urticarial vasculitis. Clin Dermatol. 1999;17:565-9.
15. Venzor J, Lee WL, Huston DP. Urticarial vasculitis. Clin Rev Allergy Immunol. 2002;23:201-16.
16. Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am. 2004;24:183-213.
17. Monroe EW. Urticarial vasculitis: An update review. J Am Acad Dermatol. 1981;5:88-95.
18. Soter NA. Chronic urticaria as a manifestation of necrotizing venulitis. N Eng J Med. 1977;296:1440-42.
19. Rivas AM, Velásquez CJ, Pinto LF, Márquez JD. Urticaria vasculítica: artículo de revisión. Revista Colombiana de Reumatología. 2009;16:154-66.
20. Warin RP. Urticarial vasculitis. Br Med J Clin Res Ed. 1983;286:1919-20.
21. Brown NA, Carter JD. Urticarial vasculitis. Curr Rheumatol Rep. 2007;9:312-9.
22. Aboobacker J, Greaves MW. Urticarial vasculitis. Clin Exp Dermatol. 1986;11:436-44.
23. Waldo FB, Leist PA, Strife CF, Forristal J, West CD. Atypical hypocomplementemic vasculitis syndrome in a child. J Pediatr. 1985;106:745-50.
24. Soylu A, Kavucku S, Uzuner N, Olgac N, Karaman O, Ozer E. Systemic lupus erythematosus presenting with normocomplementemic uritcarial vasculitis in a 4-year old girl. Pediatr Int. 2001;43:420-2.
25. Black AK, Lawfor F, Greaves MW. Consensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol. 1996;21:424-6.
26. Sánchez NP, Winkelmann RK, Schroeter AL, Dicken CH. The clinical and histopathologic spectrums of urticarial vasculitis: Study of forty cases. J Am Acad Dermatol. 1982;7:599-605.
27. Saigal K, Valencia IC, Cohen J, Kerdel FA. Hypocomplementemic urticarial vasculitis with angioedema, a rare presentation of systemic lupus aerythematosus: Rapid response to rituximab. J Am Acad Dermatol. 2003;49:S283-5.
28. Lee JSS, Loh TH, Seow SC, Tan SH. Prolonged urticaria with purpura: The spectrum of clinical and histopathologic features in a prospective series of 22 patients exhibiting the clinical features of urticarial vasculitis. J Am Acad Dermatol. 2007;56:994-1005.
29. O’Donnell B, Black AK. Urticarial vasculitis. Int Angiol. 1995;14:166-74.
30. Schwartz HR, McDuffie FC, Black LF, Schroeter AL, Conn DL. Hypocomplementemic urticarial vasculitis: Association with chronic obstructive pulmonary disease. Mayo Clin Proc. 1982;57:231-8.
31. Jones MD, Tsou E, Lack E, Cupps TR. Pulmonary disease in urticarial vasculitis: The role of bronchoalveolar lavage. Am J Med. 1990;88:431-4.
32. Soter NA. Urticarial vasculitis. In: Champion RH, Greaves MW, Kobza Black A, Pye RJ, editors. The urticarias. Edinburg: Churchill Livingston; 1985. p. 141-8.
33. Palazzo E, Bourgeois P, Meyer O, De Bandt M, Kazatchkine M, Kahn MF. Hypocomplementemic urticarial vasculitis syndrome, Jaccoud’s syndrome valvulopathy: A new syndromic combination. J Rheumatol. 1993;20:1236-40.
34. Amano H, Furuhata N, Tamura N, Tokano Y, Takasaki Y. Hypocomplementemic urticarial vasculitis with Jaccoud’s arthropathy and valvular heart disease: Case report and review of the literature. Lupus. 2008;17:837-41.
35. Dincy CVP, George R, Jacob M, Mathai E, Pulimood S, Eapen EP. Clinico-pathologic profile of normocomplementemic and hypocomplementemic urticarial vasculitis: A study from South India. J Eur Acad Dermatol Venereol. 2008;22:789-94.
36. Chen HJ, Bloch KJ. Hypocomplementemic urticarial vasculitis, Jaccoud’s arthropathy, valvular heart disease, and reversible tracheal stenosis: A surfeit of syndromes. J Rheumatol. 2001;28:383-6.
37. Davis MDP, Daoud MS, Kirby B, Gibson LE, Rogers MS. Clinicopathologic correlation of hypocomplementemic and normocomplementemic urticarial vasculitis. J Am Acad Dermatol. 1998;38:899-905.
38. Berg RE, Kantor GR, Bergfeld WF. Urticarial vasculitis. Int J Dermatol. 1988;27:468-72.
39. Callen JP, Kalbfleisch S. Urticarial vasculitis: A report of nine cases and review of the literature. Br J Dermatol. 1982;107:87-94.
40. McDuffie FC, Mitchell Sams W, Maldonado JE, Andreini PH, Conn DL, Samayoa EA. Hypocomplementemia with cutaneous vasculitis and arthritis: Possible immune complex syndrome. Mayo Clin Proc. 1973:48:340-8.
41. Worm M, Muche M, Schulze P, Sterry W, Kolde G. Hypocomplementaemic urticarial vasculitis: Successful treatment with cylophosphamide-dexamethasone pulse therapy. Br J Dermatol. 1998;139:704-7.
42. Eiser AR, Singh P, Shaines HM. Sustained dapsone induced remission of hypocomplementemic urticarial vasculitis –a case report. Angiology. 1997;48:1019-22.
43. Wisnieski JJ, Baer AN, Christensen J, Cupps TR, Flag DN, Jones JV, et al. Hypocomplementemic urticarial vasculiti syndrome: Clinical and serologic findings in 18 patients. Medicine. 1995;74:24-41.
44. Matthews CN, Saihan EM, Warin RP. Urticaria-like lesions associated with systemic lupus erythematosus: Response to dapsone. Br J Dermatol. 1978;99:455-7.
45. Ruzicka T, Goerz G. Systemic lupus erythematosus and vasculitic urticaria. Effect of dapsone and complement levels. Dermatologica. 1981;162:203-5.
46. Lopez LR, Davis KC, Kohler PF, Schocket AL. The hypocomplementemic urticarial-vasculitis syndrome: Therapeutic response to hydroxychloroquine. J Allergy ClinImmunol. 1984;73:600-3.
47. Stack PS. Methotrexate for urticarial vasculitis. Ann Allergy. 1994;72:36-8.
48. Enríquez R, Sirvent AE, Amorós F, Pérez M, Matarredona J, Reyes A. Crescentic membranoproliferative glomerulonephritis and hypocomplementemic urticarial vasculitis. J Nephrol. 2005;18:318-22.
49. Worm M, Sterry W, Kolde G. Mycophenolate mofetil is effective for maintenance therapy of hypocomplementaemic urticarial vasculitis. Br J Dermatol. 2000;143:1324.
50. Dahl MV. Clinical pearl: Diascopy helps diagnose urticarial vasculitis. J Am Acad Dermatol. 1994;30:481-2.
51. Soma J, Sato H, Ito S, Saito T. Nephrotic syndrome associated with hypocomplementemic urticarial vasculitis syndrome: Successful treatment with cyclosporin A. Nephrol Dial Transplant. 1999;14:1753-7.
52. Russell Jones R, Bhogal B, Dash A, Schifferli J. Urticaria and vasculitis: A continuum of histopathological and immunopathological changes. Br J Dermatol.1983:108:139-49.
53. Alexander JL, Kalaaji AN, Shehan JM, Yokel BK, Pittelkow MR. Plasmapharesis for refractory urticarial vasculitis in a patient with B-cell chronic lymphocytic leukemia. J Drugs Dermatol. 2006 5:534-7.
54. Staubach-Renz P, von Stebut E, Bräuninger W, Maurer M, Steinbrink K. Hypocomplementemic urticarial vasculitis syndrome. Successful therapy with intravenous immunoglobulin. Hautarzt. 2007;58:693-7.
55. Shah D, Rowbottom AW, Thomas CL, Cumber P, Chowdhury MM. Hypocomplementaemic urticarial vasculitis associated with nonHodgkin lymphoma and treatment with intravenous immunoglobulin. Br J Dermatol. 2007;157:392-3.
56. Carr DR, Heffernan MP. Off-label uses of rituximab in dermatology. Dermatol Ther. 2007;20:277-87.
57. Zeiss CR, Burch FX, Marder RJ, Furey NL, Schmid FR, Gewurz H. A hypocomplementemic vasculitic urticarial síndrome: A report of four new cases and definition of the disease. Am J Med. 1980;68:867-75.
2. Aydogan K, Karadogan SK, Adim SB, Tunali S. Hypocomplementemic urticarial vasculitis: A rare presentation of systemic lupus erythematosus. Int J Dermatol. 2006,45:1057-61.
3. O’Loughlin S, Schroeter AL, Jordon RE. Chronic urticaria-like lesions in systemic lupus erythematosus: A review of 12 cases. Arch Dermatol. 1978;114:879-83.
4. Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: A histopathologic and clinical review of 72 cases. J Am Acad Dermatol. 1992;26:441-8.
5. Buhner D, Grant JA. Serum sickness. Dermatol Clin. 1985;3:107-17.
6. Kano Y, Orihara M, Shiohara T. Cellular and molecular dynamics in exercise-induced urticarial vasculitis lesions. Arch Dermatol. 1998;134:62-7.
7. Athanasiadis GI, Pfab F, Kollmar A, Ring J, Ollert M. Urticarial vasculitis with a positive autologous serum skin test: Diagnosis and successful therapy. Allergy. 2006;61:1484-5.
8. Bakos N, Hillander M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria. Int J Dermatol. 2003;42:613-5.
9. Greaves MW. Chronic idiopathic urticaria and Helicobacter pylori –not directly causative but could there be a link? ACI International. 2001;13:23- 6.
10. Napoli DC, Freeman TM. Autoimmunity in chronic urticaria and urticarial vasculitis. Curr Allergy Asthma Rep. 2001;1:329-36.
11. Callen JP. Cutaneous vasculitis and other neutrophilic dermatoses. Curr Opin Rheumatol. 1993;5:33-40.
12. Wisnieski J. Urticarial vasculitis. Curr Opin Rheumatol. 2000;12:24-31.
13. Wisnieski JJ, Baer AN, Christensen J, Cupps TR, Flag DN, Jones JV, et al. Hypocomplementemic urticarial vasculitis syndrome: Clinical and serologic findings in 18 patients. Medicine. 1995;74:24-41.
14. Black AK. Urticarial vasculitis. Clin Dermatol. 1999;17:565-9.
15. Venzor J, Lee WL, Huston DP. Urticarial vasculitis. Clin Rev Allergy Immunol. 2002;23:201-16.
16. Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am. 2004;24:183-213.
17. Monroe EW. Urticarial vasculitis: An update review. J Am Acad Dermatol. 1981;5:88-95.
18. Soter NA. Chronic urticaria as a manifestation of necrotizing venulitis. N Eng J Med. 1977;296:1440-42.
19. Rivas AM, Velásquez CJ, Pinto LF, Márquez JD. Urticaria vasculítica: artículo de revisión. Revista Colombiana de Reumatología. 2009;16:154-66.
20. Warin RP. Urticarial vasculitis. Br Med J Clin Res Ed. 1983;286:1919-20.
21. Brown NA, Carter JD. Urticarial vasculitis. Curr Rheumatol Rep. 2007;9:312-9.
22. Aboobacker J, Greaves MW. Urticarial vasculitis. Clin Exp Dermatol. 1986;11:436-44.
23. Waldo FB, Leist PA, Strife CF, Forristal J, West CD. Atypical hypocomplementemic vasculitis syndrome in a child. J Pediatr. 1985;106:745-50.
24. Soylu A, Kavucku S, Uzuner N, Olgac N, Karaman O, Ozer E. Systemic lupus erythematosus presenting with normocomplementemic uritcarial vasculitis in a 4-year old girl. Pediatr Int. 2001;43:420-2.
25. Black AK, Lawfor F, Greaves MW. Consensus meeting on the definition of physical urticarias and urticarial vasculitis. Clin Exp Dermatol. 1996;21:424-6.
26. Sánchez NP, Winkelmann RK, Schroeter AL, Dicken CH. The clinical and histopathologic spectrums of urticarial vasculitis: Study of forty cases. J Am Acad Dermatol. 1982;7:599-605.
27. Saigal K, Valencia IC, Cohen J, Kerdel FA. Hypocomplementemic urticarial vasculitis with angioedema, a rare presentation of systemic lupus aerythematosus: Rapid response to rituximab. J Am Acad Dermatol. 2003;49:S283-5.
28. Lee JSS, Loh TH, Seow SC, Tan SH. Prolonged urticaria with purpura: The spectrum of clinical and histopathologic features in a prospective series of 22 patients exhibiting the clinical features of urticarial vasculitis. J Am Acad Dermatol. 2007;56:994-1005.
29. O’Donnell B, Black AK. Urticarial vasculitis. Int Angiol. 1995;14:166-74.
30. Schwartz HR, McDuffie FC, Black LF, Schroeter AL, Conn DL. Hypocomplementemic urticarial vasculitis: Association with chronic obstructive pulmonary disease. Mayo Clin Proc. 1982;57:231-8.
31. Jones MD, Tsou E, Lack E, Cupps TR. Pulmonary disease in urticarial vasculitis: The role of bronchoalveolar lavage. Am J Med. 1990;88:431-4.
32. Soter NA. Urticarial vasculitis. In: Champion RH, Greaves MW, Kobza Black A, Pye RJ, editors. The urticarias. Edinburg: Churchill Livingston; 1985. p. 141-8.
33. Palazzo E, Bourgeois P, Meyer O, De Bandt M, Kazatchkine M, Kahn MF. Hypocomplementemic urticarial vasculitis syndrome, Jaccoud’s syndrome valvulopathy: A new syndromic combination. J Rheumatol. 1993;20:1236-40.
34. Amano H, Furuhata N, Tamura N, Tokano Y, Takasaki Y. Hypocomplementemic urticarial vasculitis with Jaccoud’s arthropathy and valvular heart disease: Case report and review of the literature. Lupus. 2008;17:837-41.
35. Dincy CVP, George R, Jacob M, Mathai E, Pulimood S, Eapen EP. Clinico-pathologic profile of normocomplementemic and hypocomplementemic urticarial vasculitis: A study from South India. J Eur Acad Dermatol Venereol. 2008;22:789-94.
36. Chen HJ, Bloch KJ. Hypocomplementemic urticarial vasculitis, Jaccoud’s arthropathy, valvular heart disease, and reversible tracheal stenosis: A surfeit of syndromes. J Rheumatol. 2001;28:383-6.
37. Davis MDP, Daoud MS, Kirby B, Gibson LE, Rogers MS. Clinicopathologic correlation of hypocomplementemic and normocomplementemic urticarial vasculitis. J Am Acad Dermatol. 1998;38:899-905.
38. Berg RE, Kantor GR, Bergfeld WF. Urticarial vasculitis. Int J Dermatol. 1988;27:468-72.
39. Callen JP, Kalbfleisch S. Urticarial vasculitis: A report of nine cases and review of the literature. Br J Dermatol. 1982;107:87-94.
40. McDuffie FC, Mitchell Sams W, Maldonado JE, Andreini PH, Conn DL, Samayoa EA. Hypocomplementemia with cutaneous vasculitis and arthritis: Possible immune complex syndrome. Mayo Clin Proc. 1973:48:340-8.
41. Worm M, Muche M, Schulze P, Sterry W, Kolde G. Hypocomplementaemic urticarial vasculitis: Successful treatment with cylophosphamide-dexamethasone pulse therapy. Br J Dermatol. 1998;139:704-7.
42. Eiser AR, Singh P, Shaines HM. Sustained dapsone induced remission of hypocomplementemic urticarial vasculitis –a case report. Angiology. 1997;48:1019-22.
43. Wisnieski JJ, Baer AN, Christensen J, Cupps TR, Flag DN, Jones JV, et al. Hypocomplementemic urticarial vasculiti syndrome: Clinical and serologic findings in 18 patients. Medicine. 1995;74:24-41.
44. Matthews CN, Saihan EM, Warin RP. Urticaria-like lesions associated with systemic lupus erythematosus: Response to dapsone. Br J Dermatol. 1978;99:455-7.
45. Ruzicka T, Goerz G. Systemic lupus erythematosus and vasculitic urticaria. Effect of dapsone and complement levels. Dermatologica. 1981;162:203-5.
46. Lopez LR, Davis KC, Kohler PF, Schocket AL. The hypocomplementemic urticarial-vasculitis syndrome: Therapeutic response to hydroxychloroquine. J Allergy ClinImmunol. 1984;73:600-3.
47. Stack PS. Methotrexate for urticarial vasculitis. Ann Allergy. 1994;72:36-8.
48. Enríquez R, Sirvent AE, Amorós F, Pérez M, Matarredona J, Reyes A. Crescentic membranoproliferative glomerulonephritis and hypocomplementemic urticarial vasculitis. J Nephrol. 2005;18:318-22.
49. Worm M, Sterry W, Kolde G. Mycophenolate mofetil is effective for maintenance therapy of hypocomplementaemic urticarial vasculitis. Br J Dermatol. 2000;143:1324.
50. Dahl MV. Clinical pearl: Diascopy helps diagnose urticarial vasculitis. J Am Acad Dermatol. 1994;30:481-2.
51. Soma J, Sato H, Ito S, Saito T. Nephrotic syndrome associated with hypocomplementemic urticarial vasculitis syndrome: Successful treatment with cyclosporin A. Nephrol Dial Transplant. 1999;14:1753-7.
52. Russell Jones R, Bhogal B, Dash A, Schifferli J. Urticaria and vasculitis: A continuum of histopathological and immunopathological changes. Br J Dermatol.1983:108:139-49.
53. Alexander JL, Kalaaji AN, Shehan JM, Yokel BK, Pittelkow MR. Plasmapharesis for refractory urticarial vasculitis in a patient with B-cell chronic lymphocytic leukemia. J Drugs Dermatol. 2006 5:534-7.
54. Staubach-Renz P, von Stebut E, Bräuninger W, Maurer M, Steinbrink K. Hypocomplementemic urticarial vasculitis syndrome. Successful therapy with intravenous immunoglobulin. Hautarzt. 2007;58:693-7.
55. Shah D, Rowbottom AW, Thomas CL, Cumber P, Chowdhury MM. Hypocomplementaemic urticarial vasculitis associated with nonHodgkin lymphoma and treatment with intravenous immunoglobulin. Br J Dermatol. 2007;157:392-3.
56. Carr DR, Heffernan MP. Off-label uses of rituximab in dermatology. Dermatol Ther. 2007;20:277-87.
57. Zeiss CR, Burch FX, Marder RJ, Furey NL, Schmid FR, Gewurz H. A hypocomplementemic vasculitic urticarial síndrome: A report of four new cases and definition of the disease. Am J Med. 1980;68:867-75.
Cómo citar
1.
Palacios CP, Londoño Ángela, Restrepo R, Pinto LF, Velásquez CJ, Gómez LI, Chinchilla C, Tamayo L. Estudio descriptivo de urticaria vasculítica en Medellín, Colombia: características clínicas, epidemiológicas y de laboratorio. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de abril de 2013 [citado 20 de mayo de 2022];21(2):135-44. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/259
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