Cutaneous lesions and finger clubbing uncovering hypocomplementemic urticarial vasculitis and hepatitis C with mixed cryoglobulinemia

Abstract

Urticarial vasculitis is a rare clinicopathologic entity characterized by urticarial lesions that persist for more than 24 hours and histologic features of leukocytoclastic vasculitis. Patients can be divided into normocomplementemic or hypocomplementemic. The authors report the case of a healthy 49-year-old woman with a 1-year history of highly pruritic generalized cutaneous lesions and finger clubbing. Laboratory tests together with histopathologic examination allowed the diagnosis of hypocomplementemic urticarial vasculitis, chronic hepatitis C and type II mixed cryoglobulinemia. The patient started symptomatic treatment and was referred to a gastroenterologist for management of the hepatitis C, with progressive improvement of the skin condition. The development of hypocomplementemic urticarial vasculitis in the context of chronic hepatitis C is exceedingly rare and possible pathogenic mechanisms are discussed.

Comorbidity of viral hepatitis and chronic spontaneous urticaria: A systematic review

“…There is clinical and experimental evidence for circulating immune complexes (CICs) in viral hepatitis . Urticarial vasculitis in viral hepatitis can be explained by the presence of mixed cryoglobulinemia, the deposition of CICs containing viral antigens, HBsAg or HCV, in the vessel wall of urticarial lesions, and consequent activation of the complement pathway . Mixed cryoglobulinemia as well as lichen planus and porphyria cutanea tarda are the most common dermatologic manifestations of HCV infection (Table ).…”

“…11,50,51 Urticarial vasculitis in viral hepatitis can be explained by the presence of mixed cryoglobulinemia, the deposition of CICs containing viral antigens, HBsAg or HCV, in the vessel wall of urticarial lesions, and consequent activation of the complement pathway. 52,53 Mixed cryoglobulinemia as well as lichen planus and porphyria cutanea tarda are the most common dermatologic manifestations of HCV infection (Table 4). Cryoglobulins are cold-insoluble antibodies which form CICs containing rheumatoid factor, polyclonal IgG and HCV RNA and cause endorgan damage and vasculitis by precipitating in small-to mediumsized blood vessels.…”