Urticarial vasculitis: an autoimmune disorder following therapy for Hodgkin's disease

Urticarial vasculitis in northern Spain: clinical study of 21 cases

Urticarial vasculitis (UV) is a subset of cutaneous vasculitis (CV), characterized clinically by urticarial skin lesions of more than 24 hours' duration and histologically by leukocytoclastic vasculitis. We assessed the frequency, clinical features, treatment, and outcome of a series of patients with UV. We conducted a retrospective study of patients with UV included in a large series of unselected patients with CV from a university hospital. Of 766 patients with CV, UV was diagnosed in 21 (2.7%; 9 male and 12 female patients; median age, 35 yr; range, 1-78 yr; interquartile range, 5-54 yr). Eight of the 21 cases were aged younger than 20 years old. Potential precipitating factors were upper respiratory tract infections and drugs (penicillin) (n = 4; in all cases in patients aged <20 yr), human immunodeficiency virus (HIV) infection (n = 1), and malignancy (n = 1). Besides urticarial lesions, other features such as palpable purpura (n = 7), arthralgia and/or arthritis (n = 13), abdominal pain (n = 2), nephropathy (n = 2), and peripheral neuropathy (n = 1) were observed. Hypocomplementemia (low C4) with low C1q was disclosed in 2 patients. Other abnormal laboratory findings were leukocytosis (n = 7), increased erythrocyte sedimentation rate (n = 6), anemia (n = 4), and antinuclear antibody positivity (n = 2). Treatment included corticosteroids (n = 12), antihistaminic drugs (n = 6), chloroquine (n = 4), nonsteroidal antiinflammatory drugs (n = 3), colchicine (n = 2), and azathioprine (n = 1). After a median follow-up of 10 months (interquartile range, 2-38 mo) recurrences were observed in 4 patients. Apart from 1 patient who died because of an underlying malignancy, the outcome was good with full recovery in the remaining patients. In conclusion, our results indicate that UV is rare but not exceptional. In children UV is often preceded by an upper respiratory tract infection. Urticarial lesions and joint manifestations are the most frequent clinical manifestation. Low complement serum levels are observed in a minority of cases. The prognosis is generally good, but depends on the underlying disease.

Alopecia areata and multifocal bone involvement in a young adult with Hodgkin's disease

A 17-year-old girl presented with a 3 month history of alopecia areata, a generalized scaling skin, enlargement of the inguinal lymph nodes and severe back pain. Staging procedures revealed multifocal bone disease and generalized lymphadenopathy. The diagnosis of nodular sclerosing Hodgkin's disease was established by biopsies of the os ileum and a left inguinal lymph node. Complete clinical remission was achieved after 2 OPPA (vincristine, prednisone, procarbazine, and doxorubicin) and 4 COPP (cyclophosphamide, vincristine, prednisone, and procarbazine) cycles and treatment completed with involved-field irradiation. After the completion of therapy, skeletal lesions had mostly resolved or become sclerotic and the patient had normal hair regrowth and skin appearance. Conclusively, this case illustrates that alopecia areata may occur as a paraneoplastic phenomenon or an autoimmune process related to the deranged cellular immune system in children and adolescents with Hodgkin's disease.

Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome

Urticarial vasculitis is a clinicopathologic entity in which episodes of urticaria are accompanied by histopathologic features of cutaneous vasculitis. The histopathologic definition of vasculitis varies from report to report. In this article, vasculitis is defined as histopathologic features of blood vessel damage: There should be evidence of leukocytoclasis and vessel wall destruction, which may or may not be accompanied by fibrinoid deposits. Red blood cell extravasation and perivascular inflammatory cell infiltrate also may be present. The extent to which each of these elements must be present has been debated.

Lipid peroxidation and antioxidant system in the blood of patients with Hodgkin's disease

OBJECTIVES

The purpose of this study was to measure the extent of lipid peroxidation and the status of antioxidants in patients with Hodgkin's disease.

DESIGN AND METHODS

Glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities, and malondialdehyde (MDA), selenium, zinc and copper content have been measured in 20 patients with Hodgkin's disease and 30 age-matched controls.

RESULTS

Significantly higher concentrations of MDA in plasma as well as in erythrocytes were found compared to the control group. In both plasma and erythrocytes, GPX activity, selenium and zinc levels were significantly lower in patients than in controls. However, SOD activity in erythrocytes and copper levels in both plasma and erythrocytes were significantly higher in patients.

CONCLUSION

We conclude that the antioxidant system is impaired in Hodgkin's disease due to the abnormal metabolism of trace elements and antioxidant enzymes.