title: Florid urticarial vasculitis heralding a flare up of ulcerative colitis.
abstract: A 75-year-old man with ulcerative colitis (UC) and diet controlled diabetes mellitus presented with a 3-week history of slightly itchy, red plaques on both lower limbs ascending gradually to cover the trunk and arms. One week later, he developed a flare up of his UC. Routine blood tests showed modest drop in haemoglobin (122 g/L) and C reactive protein (85 mg/L). Serology was remarkable for high antiproteinase 3 (c-ANCA). Serum electrophoresis showed a mildly positive paraprotein band (γ region). Stool culture was negative. Urine analysis showed proteinuria. Skin biopsy showed features of urticarial vasculitis (UV). He underwent a flexible sigmoidoscopy after the flare up showed mildly active UC. The patient was given hydrocortisone for 7 days and then prednisolone. Both rash and UC subsided. Electrophoresis was repeated 4 weeks later showing normal pattern. Prednisolone has been gradually reduced. Although rare, UV can be considered as one of the skin manifestations of UC.
authors.affiliation: York Hospital, York, UK.
authors.forename: Evon
authors.initials: E
authors.lastname: Boules
authors.affiliation: Department of Dermatology, York Hospital, York, UK.
authors.forename: Calum
authors.initials: C
authors.lastname: Lyon
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications* / Q000473:pathology; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012867:Skin / Q000473:pathology*; D014581:Urticaria / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D011239:Prednisolone; D006854:Hydrocortisone