Diagnostics and treatment of urticarial vasculitis associated with COVID-19

Currently, the issue of COVID-19 infection remains. The potential consequences of acute infection are not yet fully understood. Dermatological manifestations of COVID-19, including urticarial vasculitis, which is poorly responsive to standard therapy, are increasingly reported.

Urticarial vasculitis is a rare dermatological manifestation of COVID-19, characterized by long-lasting welts with angioedema or without it, and histopathological features of leukocytoclastic vasculitis. Leukocytoclastic vasculitis, in turn, is a common form of small vessel vasculitis, with an inflammatory infiltrate consisting of neutrophils, fibrinoid necrosis, and nuclear debris fragmentation (leukocytoclasis). Proper nosology and classification of urticarial vasculitis based on clinical presentation and histological data are crucial.

We described a clinical case of a 54-year-old woman with urticarial vasculitis, who had no systemic diseases. The lack of response to treatment with antihistamines in combination with corticosteroids led to the initiation of colchicine as an alternative therapy. Colchicine suppresses granulocyte mitotic activity, inhibits the formation of leukotriene B4, and reduces leukocyte migration to the site of inflammation, preventing neutrophil degranulation. After treatment with colchicine at a dose of 0.5 mg twice a day for 2 months, remission and improvement of clinical symptoms were achieved.

Post-COVID syndrome with dermatological manifestations is a common issue today. Skin biopsy serves as an important tool in the differential diagnosis of chronic urticaria and urticarial vasculitis after a COVID-19 infection. This highlights the importance of studying dermatological manifestations of COVID-19 for more effective diagnosis and treatment of this disease.