Caroline Chanussot-Deprez1, María Elisa Vega-Memije2, Luis Flores-Suárez3, Celia Ríos-Romero4, Javier Cabiedes-Contreras3, Edgardo Reyes5, Lucia Rangel-Gamboa2. 1. Servicio de Dermatología Hospital General-PEMEX, Veracruz, Ver., México. 2. Subdirección de Investigación Biomédica, Hospital General Dr. Manuel Gea González, Ciudad de México, México. 3. Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, México. 4. Práctica privada, Querétaro, México. 5. Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición, Ciudad de México, México.
Abstract
Cutaneous vasculities (CV) represents a diagnostic challenge, occurs as primary cutaneous disorder or as a manifestation of other entities. Objective: To search the cause of CV. Methods: Patients with CV were prospectively evaluated. In all patients, skin biopsies were drawn, and direct immunofluorescence was done in most of the patients. American College of Rheumatology (ACR) and Chapel Hill Consensus Conference Criteria (CHCC) were used for classification. Results: 32 patients were studied. There was female predominance (71.8%). Children presented drug-associated CV or Schönlein-Henoch púrpura (SHP). Adults presented more frequently SHP, systemic lupus erythematosus or paraneoplastic vasculitis, other diagnosis as polyarteritis nodosa, microscopic polyangiitis, thrombotic vasculitis (post-puerperal), antiphospholipid syndrome, Churg-Strauss syndrome, and drug-associated CV were presented. Using the ACR and CHCC criteria, 50% of cases were classified. Discussion: In our institution, during this work the etiologic diagnostic of CV increased more than twice. However, in the case of HSV or LA and SHP none of the proposed criteria had high specificity; other parameters were used to discern between both. Six patients remained as not classified. In our view, cryoglobulins and hepatitis serology do not seem useful unless patient’s history supports they need to be done. Unclassified patients were followed-up closely for 2 years. Copyright:
Cutaneous vasculities (CV) represents a diagnostic challenge, occurs as primary cutaneous disorder or as a manifestation of other entities. Objective: To search the cause of CV. Methods:Patients with CV were prospectively evaluated. In all patients, skin biopsies were drawn, and direct immunofluorescence was done in most of the patients. American College of Rheumatology (ACR) and Chapel Hill Consensus Conference Criteria (CHCC) were used for classification. Results: 32 patients were studied. There was female predominance (71.8%). Children presented drug-associated CV or Schönlein-Henoch púrpura (SHP). Adults presented more frequently SHP, systemic lupus erythematosus or paraneoplastic vasculitis, other diagnosis as polyarteritis nodosa, microscopic polyangiitis, thrombotic vasculitis (post-puerperal), antiphospholipid syndrome, Churg-Strauss syndrome, and drug-associated CV were presented. Using the ACR and CHCC criteria, 50% of cases were classified. Discussion: In our institution, during this work the etiologic diagnostic of CV increased more than twice. However, in the case of HSV or LA and SHP none of the proposed criteria had high specificity; other parameters were used to discern between both. Six patients remained as not classified. In our view, cryoglobulins and hepatitis serology do not seem useful unless patient’s history supports they need to be done. Unclassified patients were followed-up closely for 2 years. Copyright:
Authors: Jorge Magdaleno-Tapial; Cristian Valenzuela-Oñate; Javier Pitarch-Fabregat; María Marín-Jiménez; Clara Molina Almela; Johana Isidora Gutiérrez-Salcedo; Javier Calvo-Catalá; José Luis Sánchez-Carazo; V Alegre-de Miquel Journal: JAAD Case Rep Date: 2018-10-12