Dr. Naval Mendiratta
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
For the past year, I have been having bouts of urticarial vasculitis with lumps under the skin on my upper arms which turn to large rusty red areas before bruising yellow and fading away. The rash is transient and moves around the body across thighs, etc. My knees go red and there is a blue swelling. I am having low-grade fever and malaise. Now the fingers next to the thumbs on both hands are turning in with pronounced bony lumps on the fingers on the joints nearest the nails. The neck gets stiff and the elbows have red areas too. I have a feeling in the chest though seems to be asthma-related apparently. My ESR and CRP are normal, but I have eosinophilia. My liver and kidney functions are fine, but alkaline phosphatase is borderline high. I have confirmed vitamin D deficiency and osteopenia. I have raised anticardiolipin since my mid-twenties and it never becomes normal. Can you help? My paternal grandmother had Paget's disease and rheumatoid arthritis. Low C3 and C4 have been identified in my son and also with my nephew. Currently, I am taking Venlafaxine for symptoms of menopause.
Hi,
Welcome to icliniq.com.
Well, urticaria can be very disabling. I am not sure if they did the biopsy of the lesion yet, but to label it as vasculitis we need a biopsy. The reason is a difference in management between urticarial vasculitis and urticaria. Also, could you give me more details on the treatment taken previously for urticarial vasculitis? It needs a long course with steroids along with other immunosuppression. If urticaria, we need to manage it with antiallergics in high doses. Do let me know these queries as the diagnosis is still in doubt here.
Thank you.
Patient's Query
Hi doctor,
I have only had antihistamines. I have attached a picture of the lesion for your reference.
Hi,
Welcome back to icliniq.com.
I have seen the pictures (attachment removed to protect patient identity). It is quite a big urticarial rash. I would like to know whether it has ever been biopsied. If it is vasculitis, anti-allergics will only help partially. Secondly, tell me the dosage and medications of antiallergics you are taking. As one needs to be on a higher dose of antiallergics for urticaria than the routine ones.
Thank you.
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Rheumatology
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