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Case Series of Vasculitides: An On-Call Experience

| Dermatology
Authors:
*Sue Ann Chan, Donna Thompson,
Disclosure:

The authors have declared no conflicts of interest.

Citation
EMJ Dermatol. ;5[1]:58-59. Abstract Review No. AR5.

Each article is made available under the terms of the .

The European Association of Dermatology and Venereology (EADV) annual congress is one of the most prestigious and well-attended dermatology conferences in the world. This year, the EADV successfully held its 26th annual congress in the vibrant city of Geneva, Switzerland on 13th–17th September 2017.

Our team from the Birmingham Skin Centre, Birmingham, UK, was honoured to have the opportunity to present a poster of our research at the congress. We conducted a retrospective review of the records of all patients seen in the emergency dermatology service (emergency clinics and ward reviews) between June and December 2016, to identify patients with cutaneous vasculitis and highlight trends in demographics, clinicopathological features, suspected causes, and clinical outcomes.

Cutaneous vasculitis is a clinicopathological entity induced by various underlying causes, including drugs, infections, and connective tissue diseases, and may also be idiopathic. Dermatological assessment and skin biopsies can help elucidate any underlying aetiologies.

In our case series, six of the nine patients studied had positive urinalysis, demonstrating microscopic haematuria and proteinuria; four of the six urinalysis positive patients had systemic renal involvement with raised urinary albumin/creatinine ratio (133.82 mg/mmol) at presentation. The other two patients with initial microscopic haematuria demonstrated resolution in both cutaneous lesions and clearing of microscopic haematuria in subsequent urinalysis (both with normal albumin/ creatinine ratio at presentation). One patient was confirmed to have immunoglobulin (Ig)A nephropathy on renal biopsy (perilesional skin immunofluorescence negative), whilst another patient with suspected IgA nephropathy remained under close monitoring given the risks of renal biopsy with comorbidities, including obesity and cardiomyopathy with long-term rivaroxaban.

Suspected causes of vasculitis included streptococcal infection with raised anti-streptolysin O titre (n=2), IgA nephropathy (n=2), and urosepsis (n=1). The patient with sepsis died following transfer to a tertiary hospital for renal dialysis.

Although current literature suggests that, in most instances, cutaneous vasculitis represents a self-limiting, single-episode phenomenon, our case series highlights significant morbidities and one mortality. We wish to raise awareness that patients who showed progression demonstrated abnormal laboratory investigations and urinalysis, and had more florid, cutaneous lesions at the time of diagnosis.

It was very interesting to be able to attend lectures and updates on connective tissue disorders where treatments discussed included hydroxychloroquine, quinacrine, dapsone, methotrexate, thalidomide, systemic steroids, intravenous Ig, acitretin, alitretinoin, photopheresis, and belimumab. It was also educational to be able to view poster presentations from delegates from all over the globe at the EADV congress.