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Sep 2011

Pruritic Urticarial Skin Lesions —Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(9):1097-1102. doi:10.1001/archdermatol.2011.253-b

Histologic examination showed an intense dermal neutrophilic infiltrate that was confined to the upper dermis and around the blood vessels without damaging them; therefore, vasculitis could be excluded. The neutrophils were arranged between the dermal collagen bundles in a single file. The characteristic edema of Sweet syndrome was absent.

Our patient was treated with a high-dose regimen of systemic steroids, with remission of her rash and fever, which then recurred when the dosage was tapered. Her hospital course was complicated by her progressive cardiac and renal disorder, probably as a result of a secondary amyloidosis, which may have been induced by the Schnitzler syndrome. She died a short time later without a histologic confirmation of the amyloidosis because the family did not want a necropsy.

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