Chronic Urticaria: A Rare Case Presentation

Abstract

Introduction. Urticaria is a frequent condition, characterized by the pre sence of highly pruritic, erythematous-edematous, disseminated lesions, that affects up to 20% of the general population at least once during lifetime. Chronic urticaria implies intermittent lesions, at least twice a week, for at least six weeks. It remains a significant problem in terms of etiology and diagnosis. Management of urticaria is complex and complete remission is rarely obtained. Material and methods. A 66-year-old female presented for consultation with multiple, erythematous, well-circumscribed, highly pruritic papules and plaques localized on the thorax and lower limbs, with an intermittent evolution for one year.Also, an episode of angioedema five months prior was mentioned. No specific provoking factor could be identified at initial admission. Results. Laboratory investigations were negative for infections, autoimmune or thyroid disorders. Tumor markers (CEA, CA 15.3, CA 125, CA19.9) were within normal limits. The level of Ig E antibodies was normal. However, the level of IgG antibodies to Toxoplasma gondii was found to be extremely high, reaching 46.398 UI/mL.The therapeutic approach was the administration of azithromycin 500 mg daily for 21 days and oral antihistamines, with favorable evolution. Discussions. Urticaria is one of the 10 most common dermatoses and is defined by the presence of pruritic wheal-like lesions and angioedema. In a state hospital from Bucharest, in 2017, 67% of patients presented as emergencies at the Consultation Room with acute urticaria, 21% of patients were treated as out-patients with different forms of acute and chronic urticaria, whereas 12% of admitted, in-patients presented with some form of chronic urticaria. This paper reports a severe case of chronic urticaria, with a long history of recurring, disseminated lesions for almost one year. Specific associations and aspects were identified. A correct and rapid diagnosis is essential in this pathology for improving quality of life for these patients. Conclusions. CU is a frequent condition with a major impact on the quality of life for patients. Although most cases remain without a known cause, a correct and thorough approach of the patient should be chosen. Peculiar causes should be taken into consideration and frequently a multidisciplinary perspective is the best choice.In this case report, a long-term evolution of CU with a significant impact on the quality of life for this patient identified a rare association with a Toxoplasma gondii infection with a favorable outcome.