title: A case of urticarial vasculitis in a female patient with lupus: Mycoplasma pneumoniae infection or lupus reactivation?
abstract: A 17-year-old female patient affected by systemic lupus erythematosus (SLE) (who had been taking 300 mg/die of hydroxychloroquine for 3 years), Graves' disease (treated with 10 mg/die of tapazole), and celiac disease came to our attention for urticarial vasculitis. She had been taking prednisone (25 mg/die) for 3 days, and her blood tests showed high levels of Mycoplasma pneumoniae IgM and IgG antibodies. The association between urticaria and M. pneumoniae infections can be present in up to 7% of the cases and, to the best of our knowledge, only two reports of urticarial vasculitis and M. pneumoniae in adults are available in the literature. Urticarial vasculitis can also be a rare cutaneous manifestation of SLE (affecting 2% of the patients), and our case is the first in the literature describing the coexistence of M. pneumoniae infection, SLE, and urticarial vasculitis in a pediatric patient, a case that rises an important differential diagnosis issue about the origin of urticarial vasculitis: SLE reactivation or urticarial vasculitis due to M. pneumoniae infection?
authors.affiliation: Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy. mario.diplomatico@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Diplomatico
authors.affiliation: Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Gicchino
authors.affiliation: Pediatric Dermatology Unit, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon di Napoli, Naples, Italy.
authors.forename: Orsola
authors.initials: O
authors.lastname: Ametrano
authors.affiliation: Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Marzuillo
authors.affiliation: Department of Woman, Child and of General and Specialized Surgery, Università della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
authors.forename: Alma Nunzia
authors.initials: AN
authors.lastname: Olivieri
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis*; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D011019:Pneumonia, Mycoplasma / Q000150:complications / Q000175:diagnosis*; D012008:Recurrence; D014581:Urticaria / Q000175:diagnosis* / Q000209:etiology; D014657:Vasculitis / Q000175:diagnosis* / Q000209:etiology
keywords: Children; Mycoplasma pneumoniae; Systemic lupus erythematosus; Urticarial vasculitis