Urticarial vasculitis associated with post-streptococcal disease in children: a case report

Ida Bagus Ramajaya Sutawan; Azwin Mengindra Putera; Zahrah Hikmah; Anang Endaryanto

doi:10.15562/bmj.v12i1.3841

Urticarial vasculitis associated with post-streptococcal disease in children: a case report

Ida Bagus Ramajaya Sutawan ,

Azwin Mengindra Putera ,

Zahrah Hikmah ,

Anang Endaryanto ,

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DOI: https://doi.org/10.15562/bmj.v12i1.3841 |
Published: 2023-02-01

Abstract

Background: Urticarial vasculitis (UV) is a rare clinicopathologic, especially among children and infants. Most urticarial vasculitis is caused by unknown etiology. Rarely has it been linked to post-streptococcal disease as a non-suppurative complication of a streptococcus infection. Treatment of urticarial vasculitis can be challenging. It is based on the clinical phenotype, systemic symptoms, and/or underlying diseases.

Case Presentation: This study reports a case of a child with an itchy but more painful and burning sensations urticarial lesion which persisted for more than 24 hours, left a residual ecchymotic hyperpigmentation lesion when resolved, and was accompanied by systemic symptoms such as joint pain, fatigue, and gastrointestinal symptoms. The symptoms were preceded by signs of pharyngitis one week before the symptoms and supported by an increase in ASO titer that raised the suspicion of a previous recent streptococcal infection. Skin biopsy revealed a leukocytoclastic vasculitis, a specific finding supporting the diagnosis of urticarial vasculitis. The combination of antibiotics, antihistamines, and corticosteroids gave our case a good clinical response and outcome.

Conclusion: A high awareness of urticarial vasculitis linked to post-streptococcal diseases is needed to establish prompt treatment and prevent further complications.

References

Kolkhir P, Bonnekoh H, Kocatürk E, Hide M, Metz M, Sánchez-Borges M, et al. Management of urticarial vasculitis: A worldwide physician perspective. World Allergy Organ J. 2020;13(3):100107.
Kolkhir P, Grakhova M, Bonnekoh H, Krause K, Maurer M. Treatment of urticarial vasculitis: A systematic review. J Allergy Clin Immunol. 2019;143(2):458–466.
Gu SL, Jorizzo JL. Urticarial vasculitis. Int J Women’s Dermatology. 2021;7(3):290–297.
Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy Eur J Allergy Clin Immunol. 2018;73(7):1393–1414.
Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CEH, Greaves MW, Henz BM, et al. EAACI/GA2LEN/EDF guideline: Definition, classification and diagnosis of urticaria. Allergy Eur J Allergy Clin Immunol. 2006;61(3):316–320.
Sjöwall C, Mandl T, Skattum L, Olsson M, Mohammad AJ. Epidemiology of hypocomplementaemic urticarial vasculitis (anti-C1q vasculitis). Rheumatology (Oxford). 2018;57(8):1400–1407.
Venzor J, Lee WL, Huston DP. Urticarial Vasculitis. Clin Rev Allergy Immunol. 2002;23(2):201–216.
Marzano AV, Maronese CA, Genovese G, Ferrucci S, Moltrasio C, Asero R, Cugno M. Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis. J Allergy Clin Immunol. 2022;149(4):1137-1149.
Chang S, Carr W. Urticarial vasculitis. Allergy asthma Proc. 2007;28(1):97–100.
Ivory D, Folzenlogen D. Post Streptococcal Syndromes, A Rheumatologist Perspective. Internet J Rheumatol. 2010;6(2):1–12.
Hahn RG, Knox LM, Forman TA. Evaluation of Poststreptococcal Illness. Am Fam Physician. 2005;71(10):1949–1954.
Martins AL, Figueiredo AE, Brito MJ. Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome. Clin Res Infect Dis. 2015;2(1):2–4.
Mehregan DR, Gibson LE. Pathophysiology of urticarial vasculitis. Arch Dermatol. 1998;134(1):88–89.
Radonjic-Hoesli S, Hofmeier KS, Micaletto S, Schmid-Grendelmeier P, Bircher A, Simon D. Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol. 2018;54(1):88–101.
Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am. 2004;24(2):183–213.
Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: A histopathologic and clinical review of 72 cases. J Am Acad Dermatol. 1992;26(3):441–448.
Buck A, Christensen J, McCarty M. Hypocomplementemic urticarial vasculitis syndrome: a case report and literature review. J Clin Aesthet Dermatol. 2012;14(5):36–46.
Stumpf MAM. Normocomplementemic Idiopathic Urticarial Vasculitis. J Med. 2021;22(1):67–68.
Hamad A, Jithpratuck W, Krishnaswamy G. Urticarial vasculitis and associated disorders. Ann Allergy, Asthma Immunol. 2017;118(4):394–398.
Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease. Circulation. 2009;119(111):1541–1551.
Handoyo V, Pertiwi GAR, Prabawa IPY, Manuaba IBAP, Bhargah A, Budiana IPG. Management of ST-elevation myocardial infarction in the setting of anterior epistaxis: focused on antiplatelet and antithrombotic therapies. Int Med Case Rep J. 2019;12:33-38.
Devi AK, Utomo B, Indramaya DM, Listiawan MY, Sawitri, Murtiastutik D, et al. Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Bali Medical Journal. 2022;11(1):166–173.

[1] Kolkhir P, Bonnekoh H, Kocatürk E, Hide M, Metz M, Sánchez-Borges M, et al. Management of urticarial vasculitis: A worldwide physician perspective. World Allergy Organ J. 2020;13(3):100107.

[2] Kolkhir P, Grakhova M, Bonnekoh H, Krause K, Maurer M. Treatment of urticarial vasculitis: A systematic review. J Allergy Clin Immunol. 2019;143(2):458–466.

[3] Gu SL, Jorizzo JL. Urticarial vasculitis. Int J Women’s Dermatology. 2021;7(3):290–297.

[4] Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy Eur J Allergy Clin Immunol. 2018;73(7):1393–1414.

[5] Zuberbier T, Bindslev-Jensen C, Canonica W, Grattan CEH, Greaves MW, Henz BM, et al. EAACI/GA2LEN/EDF guideline: Definition, classification and diagnosis of urticaria. Allergy Eur J Allergy Clin Immunol. 2006;61(3):316–320.

[6] Sjöwall C, Mandl T, Skattum L, Olsson M, Mohammad AJ. Epidemiology of hypocomplementaemic urticarial vasculitis (anti-C1q vasculitis). Rheumatology (Oxford). 2018;57(8):1400–1407.

[7] Venzor J, Lee WL, Huston DP. Urticarial Vasculitis. Clin Rev Allergy Immunol. 2002;23(2):201–216.

[8] Marzano AV, Maronese CA, Genovese G, Ferrucci S, Moltrasio C, Asero R, Cugno M. Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis. J Allergy Clin Immunol. 2022;149(4):1137-1149.

[9] Chang S, Carr W. Urticarial vasculitis. Allergy asthma Proc. 2007;28(1):97–100.

[10] Ivory D, Folzenlogen D. Post Streptococcal Syndromes, A Rheumatologist Perspective. Internet J Rheumatol. 2010;6(2):1–12.

[11] Hahn RG, Knox LM, Forman TA. Evaluation of Poststreptococcal Illness. Am Fam Physician. 2005;71(10):1949–1954.

[12] Martins AL, Figueiredo AE, Brito MJ. Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome. Clin Res Infect Dis. 2015;2(1):2–4.

[13] Mehregan DR, Gibson LE. Pathophysiology of urticarial vasculitis. Arch Dermatol. 1998;134(1):88–89.

[14] Radonjic-Hoesli S, Hofmeier KS, Micaletto S, Schmid-Grendelmeier P, Bircher A, Simon D. Urticaria and Angioedema: an Update on Classification and Pathogenesis. Clin Rev Allergy Immunol. 2018;54(1):88–101.

[15] Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am. 2004;24(2):183–213.

[16] Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: A histopathologic and clinical review of 72 cases. J Am Acad Dermatol. 1992;26(3):441–448.

[17] Buck A, Christensen J, McCarty M. Hypocomplementemic urticarial vasculitis syndrome: a case report and literature review. J Clin Aesthet Dermatol. 2012;14(5):36–46.

[18] Stumpf MAM. Normocomplementemic Idiopathic Urticarial Vasculitis. J Med. 2021;22(1):67–68.

[19] Hamad A, Jithpratuck W, Krishnaswamy G. Urticarial vasculitis and associated disorders. Ann Allergy, Asthma Immunol. 2017;118(4):394–398.

[20] Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease. Circulation. 2009;119(111):1541–1551.

[21] Handoyo V, Pertiwi GAR, Prabawa IPY, Manuaba IBAP, Bhargah A, Budiana IPG. Management of ST-elevation myocardial infarction in the setting of anterior epistaxis: focused on antiplatelet and antithrombotic therapies. Int Med Case Rep J. 2019;12:33-38.

[22] Devi AK, Utomo B, Indramaya DM, Listiawan MY, Sawitri, Murtiastutik D, et al. Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Bali Medical Journal. 2022;11(1):166–173.

Urticarial vasculitis associated with post-streptococcal disease in children: a case report

Abstract

References

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