Estudio descriptivo de urticaria vasculítica en Medellín, Colombia: características clínicas, epidemiológicas y de laboratorio

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Artículo de investigación
Rev Asoc Colomb Dermatol. 2013; 21: 2 (Abril-Junio), 135-144

Estudio descriptivo de urticaria vasculítica en Medellín, Colombia: características clínicas, epidemiológicas y de laboratorio

Urticarial vasculitis descriptive study in Medellín, Colombia: Clinical, epidemiological and laboratory findings
Autor(es): 
Claudia Patricia Palacios
claupala@yahoo.com
Médica, residente de Dermatología, Universidad Pontificia Bolivariana, Medellín, Colombia
Ángela Londoño
Médica dermatóloga, epidemióloga; docente, Clínica Universitaria Bolivariana, Medellín, Colombia Médico dermatopatólogo; docente, Universidad Pontificia Bolivariana, Medellín, Colombia
Rodrigo Restrepo
Médico reumatólogo; docente, Hospital Pablo Tobón Uribe, Medellín, Colombia
Luis Fernando Pinto
Estudiante de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
Carlos Jaime Velásquez
Estudiante de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
Laura Isabel Gómez
. Médico pediatra, alergólogo; docente, Universidad de Antioquia, IPS Universitaria, Medellín, Colombia
Carlos Chinchilla
. Médica dermatóloga, alergóloga; docente, Clínica Universitaria Bolivariana, IPS Universitaria-Universidad de Antioquia, Medellín, Colombia
Liliana Tamayo
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.

Palabras clave: 
Urticaria, vasculitis, epidemiología.

Summary: 

Objective: To study the clinical and laboratory characteristics of patients with urticarial vasculitis of patients treated at the Hospital Pablo Tobón Uribe, Clínica Universitaria Bolivariana, and IPS Universitaria in the period between 2006 and 2012.

Materials and methods: A retrospective observational study was carried out at the Hospital Pablo Tobón Uribe, Clínica Universitaria Bolivariana, IPS universitaria in Medellin and prospectively evaluated patients were also included.

Results: Twenty four patients entered the study, 20 women (83.3%), and the average age of onset of lesions was 41.8 years. A normal C3 value was found in 79% and 70.8% had normal C4 values. Symptoms associated with hives were investigated and pain was found in 20.8%, burning in 29.2%, and 50% were asymptomatic. Arthralgia, rhinitis, arthritis and atopic dermatitis were found more frequently in patients evaluated. Dapsone, colchicine, steroids, and antihistamines were among the most widely used treatments.

Conclusions: This study presents data demographic, clinical and laboratory findings of patients with urticarial vasculitis in our environment, allowing us to
compare our results with other series worldwide.

Key words: 
Urticaria, vasculitis, epidemiology
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Referencias

  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 vasculí- tica: artículo de revisión. Revista Colombiana de Reumatología. 2009;16:154-66. 143
  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.
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