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Gozzi L, Cozzi D, Zantonelli G, Giannessi C, Giovannelli S, Smorchkova O, Grazzini G, Bertelli E, Bindi A, Moroni C, Cavigli E, Miele V. Lung Involvement in Pulmonary Vasculitis: A Radiological Review. Diagnostics (Basel) 2024; 14:1416. [PMID: 39001306 PMCID: PMC11240918 DOI: 10.3390/diagnostics14131416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
Pulmonary vasculitis identifies a heterogeneous group of diseases characterized by inflammation, damage and necrosis of the wall of pulmonary vessels. The most common approach to classify vasculitis is according to etiology, therefore dividing them into primary and secondary, with a further sub-classification of primary vasculitis based on the size of the affected vessels (large, medium, and small). Pulmonary involvement is frequently observed in patients with systemic vasculitis and radiological presentation is not pathognomonic, but may vary between diseases. The main findings using high-resolution computed tomography (HRCT) include small vessel wall thickening, nodular lesions, cavitary lesions, reticular opacities, ground-glass opacities (GGO), consolidations, interlobular septal thickening, tracheobronchial stenosis, and aneurysmal dilatation of pulmonary arteries, with or without pleural effusion. Radiological diagnosis alone is difficult since signs and symptoms of lung vessel involvement are often non-specific and might overlap with other conditions such as infections, connective tissue diseases and neoplasms. Therefore, the aim of this review is to describe the most common radiological features of lung involvement in pulmonary vasculitis so that, alongside detailed clinical history and laboratory tests, a prompt diagnosis can be performed.
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Affiliation(s)
- Luca Gozzi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Zantonelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Caterina Giannessi
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Simona Giovannelli
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Olga Smorchkova
- Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, 50135 Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
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Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis. J Allergy Clin Immunol 2022; 149:1137-1149. [PMID: 35396080 DOI: 10.1016/j.jaci.2022.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 12/22/2022]
Abstract
Urticarial vasculitis (UV) is a rare cutaneous vasculitis of small vessels characterized by recurrent episodes of wheal-like lesions that tend to last more than 24 hours, healing with a residual ecchymotic postinflammatory hyperpigmentation. The histopathologic pattern of UV is that of leukocytoclastic vasculitis, consisting of fibrinoid necrosis of dermal vessels' walls and neutrophil-rich perivascular inflammatory infiltrates. Although its etiopahogenesis remains still undefined, UV is now regarded as an immune complex-driven disease with activation of the complement cascade, leading to exaggerated production of anaphylatoxins that are responsible for neutrophil recruitment and activation. This condition can be categorized into 2 main entities according to serum complement levels: normocomplementemic UV and hypocomplementemic UV, the latter being associated with circulating anti-C1q autoantibodies and possible extracutaneous manifestations. Systemic multiorgan involvement may be seen particularly in syndromic hypocomplementemic UV, also known as McDuffie syndrome. This review summarizes the clinicopathological and laboratory features as well as the underlying pathophysiological mechanisms of UV. A focus on its main differential diagnoses is provided, that is, chronic spontaneous urticaria, bullous pemphigoid, IgA (Henoch-Schönlein purpura) and IgM/IgG immune complex vasculitis, lupus erythematous tumidus, Wells syndrome, erythema multiforme, cutaneous mastocytosis, cryopyrin-associated periodic syndromes, and coronavirus disease 2019-associated and anti-severe acute respiratory syndrome coronavirus 2-vaccine-associated urticarial eruptions.
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Gu SL, Jorizzo JL. Urticarial vasculitis. Int J Womens Dermatol 2021; 7:290-297. [PMID: 34222586 PMCID: PMC8243153 DOI: 10.1016/j.ijwd.2021.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/19/2023] Open
Abstract
Urticarial vasculitis is a rare clinicopathologic entity that is characterized by chronic or recurrent episodes of urticarial lesions. Skin findings of this disease can be difficult to distinguish visually from those of chronic idiopathic urticaria but are unique in that individual lesions persist for ≥24 hours and can leave behind dusky hyperpigmentation. This disease is most often idiopathic but has been linked to certain drugs, infections, autoimmune connective disease, myelodysplastic disorders, and malignancies. More recently, some authors have reported associations between urticarial vasculitis and COVID-19, as well as influenza A/H1N1 infection. Urticarial vasculitis can extend systemically as well, most often affecting the musculoskeletal, renal, pulmonary, gastrointestinal, and ocular systems. Features of leukocytoclastic vasculitis seen on histopathologic examination are diagnostic of this disease, but not always seen. In practice, antibiotics, dapsone, colchicine, and hydroxychloroquine are popular first-line therapies, especially for mild cutaneous disease. In more severe cases, immunosuppressives, including methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine, as well as corticosteroids, may be necessary for control. More recently, select biologic therapies, including rituximab, omalizumab, and interleukin-1 inhibitors have shown promise for the treatment of recalcitrant or refractory cases.
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Affiliation(s)
- Stephanie L. Gu
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- Corresponding author.
| | - Joseph L. Jorizzo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Berry EC, Wells J, Morey A, Anantharajah A. Hypocomplementemic urticarial vasculitis syndrome presenting with bilateral scleritis. BMJ Case Rep 2021; 14:14/5/e240041. [PMID: 33972296 PMCID: PMC8112411 DOI: 10.1136/bcr-2020-240041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare autoimmune disorder characterised by recurrent urticarial lesions and acquired hypocomplementemia with systemic manifestations. The authors present the case of a 70-year-old man who presented to the ophthalmology clinic with bilateral scleritis and ocular hypertension. He was diagnosed with HUVS after a 6-month period of bilateral scleritis, vestibulitis, significant weight loss, mononeuritis multiplex and recurrent urticarial vasculitis with pronounced persistent hypocomplementemia and the presence of anti-C1q antibodies. Disease control was eventually obtained with mycophenolate and prednisolone.
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Affiliation(s)
- Ella Claire Berry
- Canberra Health Services Library, ACT Government, Garren, Australian Capital Territory, Australia .,Ophthalmology Unit, Canberra Health Services, Garran, Australian Capital Territory, Australia
| | - Jane Wells
- Ophthalmology Unit, Canberra Health Services, Garran, Australian Capital Territory, Australia.,Department of Ophthalmology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Adrienne Morey
- ACT Pathology, Canberra Health Services, Garran, Australian Capital Territory, Australia.,Australian National University Medical School, Garran, Australian Capital Territory, Australia
| | - Anthea Anantharajah
- Department of Immunology, Canberra Health Services, Garran, Australian Capital Territory, Australia.,John Curtin School of Medical Research, Canberra, Australian Capital Territory, Australia
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Horai Y, Ishikawa H, Iwanaga N, Izumi Y, Matsuoka Y, Miura S, Kawakami A. Development of hypocomplementemic urticarial vasculitis during certolizumab pegol treatment for rheumatoid arthritis: A case report. J Clin Pharm Ther 2020; 45:1179-1182. [PMID: 31990069 DOI: 10.1111/jcpt.13117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tumour necrosis factor-α-blocking agents potentially cause vasculitis. However, no study has reported on the association between hypocomplementemic urticarial vasculitis (HUV) and certolizumab pegol (CZP) usage. CASE DESCRIPTION We present the first case of HUV development during CZP treatment for rheumatoid arthritis. Hypocomplementemic urticarial vasculitis improved after CZP was discontinued and the dose of oral prednisolone was increased. WHAT IS NEW AND CONCLUSION Clinicians should be aware about the potential development of HUV during CZP treatment, which is presumed to be safe considering its unique structural characteristics that differ from those of other tumour necrosis factor-α-blocking agents.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Hiroshi Ishikawa
- Department of Dermatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yuki Matsuoka
- Department of Pathology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shiro Miura
- Department of Pathology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Atsushi Kawakami
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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