Normocomplementemic Urticarial Vasculitis Associated with A/H1N1 in a Child. Case Report
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MEDICINE
Normocomplementemic Urticarial Vasculitis Associated with A/H1N1 in a Child. Case Report Şule Gökçe 1
&
Burçe Emine Dörtkardeşler 1 & Aslı Aslan 2
Accepted: 19 November 2020 / Published online: 25 November 2020 # Springer Nature Switzerland AG 2020
Abstract Urticarial vasculitis is an entity characterized by urticarial rashes that are typically pruritic and painful, associated with angioedema and purpura. Influenza viruses are common respiratory pathogens that can cause seasonal infections and global human morbidity/mortality. A 4.5-year-old girl presented with fever and painful urticarial skin lesions leaving post-inflammatory hyperpigmentation. The nasal specimens showed a positive for influenza A/H1N1. On the basis of these findings, a diagnosis of urticarial vasculitis associated with A/H1N1 was concluded. Taking the results together, we suggest that urticarial vasculitic lesions can be considered to the list of cutaneous manifestations during the seasonal flu. Keywords Child . Vasculitis . Urticarial vasculitis . Influenza infection
Introduction Generally, influenza infection is an acute, self-limited, and uncomplicated disease that is caused by influenza A and B, and occurs every winter season [1]. Abrupt onset of fever, headache, myalgia, cough, sore throat, and rhinitis is mentioned as frequent clinical manifestations of uncomplicated influenza infections [1, 2]. Cutaneous involvement with both influenza infection and vaccination has been reported as a macular/maculopapular rash or vasculitic/purpuric eruption [3]. Urticarial vasculitis (UV) is a type of leukocytoclastic vasculitis that may present with a generalized urticarialappearing eruption, fever, and arthralgias. This is a
clinicopathologic entity thought to be mediated by a TypeIII hypersensitivity reaction mediated by antigen-antibody complexes deposited on vascular endothelium creating inflammation and vasculitis. Urticarial lesions are typically fixed for more than 24 h and may be associated with petechiae, purpura, or post-inflammatory hyperpigmentation. The prevalence is unknown and occurs in middle-aged women being rare in children [3, 4]. Leukocytoclastic vasculitis following seasonal influenza vaccination has been reported in several cases [5]. However, urticarial vasculitis associated with A/H1N1 infection has not been reported previously. This case describes a 4.5-year-old girl who presented with fever and painful urticarial skin lesions, and diagnosed with A/H1N1 associated with urticarial vasculitis.
This article is part of the Topical Collection on Medicine * Şule Gökçe [email protected] Burçe Emine Dörtkardeşler [email protected] Aslı Aslan [email protected] 1
Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit, Ege University Childrens’ Hospital, Bornova, 35040 Izmir, Turkey
2
Department of Medical Genetics, Faculty of Medicine, Ege University, 35100 Izmir, Turkey
Case Report A previously healthy 4.5-year-old girl was admitted to our outpatient department with a
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