Urticarial vasculitis
Introduction
Introduction to urticaria vasculitis Urticarial vasculitis (UV) was first reported by MCDuffie in 1973. It is characterized by a rash that is a wheal and has a long duration with hypocomplementemia. Inflammatory mediators damage vascular endothelial cells, and thus vasculitis changes, showing the manifestations of leukocyte rupture vasculitis, the cause of which is unknown. It has been reported to be caused by iodine allergy, repeated cold stimuli, and allergens such as viruses, bacteria, and parasites. Sensitive vasculitis. basic knowledge The proportion of sickness: 0.004% - 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Causes of urticaria vasculitis
Etiology and pathogenesis: This disease is a new immune complex disease, the etiology and pathogenesis is extremely complicated.
1. The factors inducing urticaria vasculitis are unknown. It is reported that allergic reactions such as chemical substances, drugs (such as iodine), repeated cold stimulation, and hypersensitivity caused by viruses, bacteria, parasites and other allergens. inflammation.
2, damage of circulating immune complexes, anti-endothelial cell antibodies and cellular immune response antigen-antibody immune complexes cause C1q binding or activation under the action of low molecular weight precipitin, further leading to complement activation of traditional pathways, producing anaphylatoxins and neutrophils Granulocyte chemokines, these inflammatory mediators can damage vascular endothelial cells, leading to the occurrence of vasculitis. Some scholars pointed out that the relationship between this disease and connective tissue disease should be taken seriously.
3. Arthus responds to leukocyte fragmentation vasculitis (local skin reaction) caused by IgG, IgM-mediated type III allergies.
Prevention
Urtic vasculitis prevention
Because the cause of the disease is unknown, there is no effective preventive measure. It is reported that the disease is caused by an allergic reaction, so it should be strictly checked when the disease occurs. Once it is determined to be caused by an allergen, the allergen should be removed immediately, and allergies should be avoided. The original contact, at the same time should be properly exercised to improve the body's immunity and improve allergies.
Complication
Urtic vasculitis complications Complications
The complications of this disease are: shock, left heart failure, double upper limb pain and other serious diseases, so active treatment should be actively given, and the main reason for the ineffective treatment of this disease is because of chronic obstructive respiratory disease. And acute laryngeal edema.
1. Chronic obstructive respiratory disease
Chronic obstructive respiratory disease is a disease caused by chronic lesions that is blocked by airways. It is generally referred to as chronic bronchitis and emphysema. The symptoms may not be easily detected at the beginning, but as the disease progresses, the symptoms gradually become more common. Exacerbation, the general symptoms are: frequent cough, easy to asthma, although chronic bronchitis and emphysema worsening, but it will damage the respiratory system, affect lung function, can also lead to pneumonia, and even death.
2, acute laryngeal edema
Mainly manifested as difficulty breathing, cyanosis of the lips, coughing in the early stage. Severe cases can cause paralysis and death. Especially for children, it is a dangerous emergency. Because of the narrow throat and small loose tissue of the mucous membrane in children, After tracheal intubation, it is prone to laryngeal edema and laryngeal obstruction, so it should be actively prevented and treated.
Symptom
Urticaria angiitis symptoms Common symptoms Joint pain wheal swollen lymph nodes swelling like urticaria skin... Itching punctate hemorrhagic fever accompanied by rash hyperthermia pigmentation and hypopigmentation
The main clinical manifestations of urticaria vasculitis are as follows:
1 The disease is more common in middle-aged women. The age of onset is mostly between 30 and 40 years old. When it starts, it is often accompanied by irregular fever, sometimes reaching 38-39 °C.
2 The main feature of the skin is wheal, which is very similar to urticaria. However, the typhoid skin lesions last for a long time, often 24 to 72 hours, or even disappear for several days. Feel itch or burning sensation. The wind group is infiltrated, and sometimes spotted bleeding can be seen in the lesion. In a few cases, there are blisters, but no necrosis; pigmentation or desquamation remains after the damage subsides.
3 This disease is often accompanied by joint pain and arthritis, mainly found in joints of the extremities, sometimes joint swelling, abdominal discomfort, lymphadenopathy, etc., kidney damage may occur in the advanced stage, epilepsy may occur in a few cases, meningitis and unilateral Optic neuritis, etc., vasculitic urticaria is often an early symptom of dermatomyositis, allergic vasculitis, SLE, etc., so the course of disease should be closely observed.
Examine
Examination of urticaria vasculitis
Laboratory tests showed increased erythrocyte sedimentation rate, decreased serum complement levels, positive antibody titers (ANA, ENA dsDNA, SSA, SM), rheumatoid factor-positive, and increased circulating immune complexes.
There are two commonly used auxiliary examination methods that can be used for this disease:
(1) Blood routine examination can be found that the surrounding white blood cells are normal or increased, the proportion of neutrophils is increased, and the blood sedimentation is fast. The severe and persistent hypocomplementemia is the most common, especially the decrease of complement C4 is more obvious.
(2) Direct fluoroscopy showed Ig and complement deposition on and around the vessel wall.
Diagnosis
Diagnosis and identification of urticaria vasculitis
diagnosis
Mainly based on clinical manifestations and laboratory tests to diagnose: clinical manifestations mainly for skin wheal lasting more than 24 hours; with fever, joint pain, abdominal pain, etc., lymphadenopathy, severe renal damage, laboratory indicators, dermal endothelium The cells are swollen, there are more neutrophils around the blood vessels, nuclear dust and red blood cells spill out, fibrin-like degeneration of blood vessel walls, rapid blood sedimentation, severe and persistent hypocomplementemia, histopathological examination shows leukocyte fragmentation vessels Inflammation, direct fluoroscopy revealed Ig and complement deposition in and around the vessel wall.
Urticaria has characteristic clinical manifestations such as wheal, so the diagnosis is not difficult. The wheal lasts for more than 24 hours with hypo-complementemia. Histologically, the manifestation of leukocyte vasculitis can be diagnosed as urticaria. inflammation.
Differential diagnosis
1. Chronic urticaria is sometimes seen in histological swelling of vascular endothelial cells. In addition to monocytes, there are also neutrophil infiltration, and nuclear dust is also visible. Most of the inflammatory cells infiltrate the vascular wall, but no fibrosis. , characteristics of necrotic vasculitis such as necrosis.
2, the disease also needs to be differentiated from systemic lupus erythematosus (SLE), the former in addition to pathological examination, can also be distinguished by a simple "slide film rash": using a slide on the UV lesion, the original Some erythema subsided, and the clinically inconspicuous purpura became visible to the naked eye. According to UV patients, anti-ds2DNA antibody and anti-Sm antibody were negative, with no or only slight visceral damage, and can be differentiated from SLE.
