History/Physical: This 53 yo woman presented with a 15 year history of a painful and disabling dermatitis of her buttocks and to a lesser extent face, extremities and torso. She has been seen by many dermatologists, allergists, gynecologists and primary care physicians during this time and even underwent a hysterectomy in an attempt to cure her when the mistaken diagnosis of autoimmune progesterone dermatitis was rfendered. Her partner recently left her because of the disabling nature of dermatitis.
Routine lab studies are unremarkable and ANA was negative. Some special tests are pending.
Clinical Images
March 2024
Shoulder
Histopathology: Biopsy were taken from the left and right buttock: Both specimens contain a small vessel vasculitis. The more recent lesions on the right buttock show the changes of leukocytoclastic vasculitis.
Biopsy from left buttock, March 2024. Four mm punch biopsied from each buttock showed similar changes, but left buttock had a more psoriasiform epidermis.
Thanks to Dr. David Jones, dermato- pathologist, Berkshire Medical Center, for the histopath images.
Tentative Diagnosis: Urticarial Vasculitis
She is being presented your thoughts and recommendations. Complement levels are pending. She has a very high deductable so we are limiting extensive testing that may be unnecessary.
Photo after 5 days of prednisone 20 mg b.i.d.
Reference:
Stephanie L Gu, Joseph L Jorizzo. Urticarial vasculitis. Int J Womens Dermatol. 2021 Jan 29;7(3):290-297. PMID: 34222586 PMCID: PMC8243153 (Full Text)
