Refractory Urticarial Vasculitis Responsive to Methotrexate: Could It Be a New Treatment Option?

Abstract

Objective: Urticarial vasculitis is a chronic clinicopathologic entity characterized by clinically characterized urticarial rash, histopathologically characterized by leukocytoclastic vasculitis. The pathogenesis is thought to be developed by a type III hypersensitivity reaction similar to leukocytoclastic vasculitis. Methods: Antihistamines and/or corticosteroids (systemic/local) may be used in patients with limited normocomplementemic urticarial vasculitis. In the literature, severe cases treated with dapsone, colchicine, hydroxychloroquine, pentoxifylline, omalizumab, mycophenolate mofetil, rituximab, cyclosporine, intravenous immunoglobulin, and cyclophosphamide have been reported in the case reports. Results: In this case, the patient, whose symptoms had not previously responded to treatment with antihistamines, steroids, cyclosporine, and omalizumab, responded to treatment with methotrexate. Conclusion: This case report recommends that methotrexate therapy may be a treatment option for cases of resistant urticarial vasculitis.

Case of benralizumab‐induced exacerbations of chronic spontaneous urticaria

“…The possibility of the formation of immune complexes against benralizumab in the blood, which then deposit in the vessel walls and activate the complement system, with the development of urticarial vasculitis (UV) should be considered. The urticarial wheals of UV persist for more than 24 h in most patients, sometimes up to 72 h, and are resistant to treatment with antihistamines 15 . Although UV mainly affects the skin, it can also affect other organ systems and lead to hypocomplementemia.…”

“…The urticarial wheals of UV persist for more than 24 h in most patients, sometimes up to 72 h, and are resistant to treatment with antihistamines. 15 Although UV mainly affects the skin, it can also affect other organ systems and lead to hypocomplementemia. It may occur in association with autoimmune diseases, drug reactions, infections, or malignancy.…”