Urticarial vasculitis:

An unusual manifestation of ‘rhupus’

Authors

  • Prashant Kaushik, M.D. Northeastern Health System, Oklahoma State University College of Osteopathic Medicine Center for Health Sciences at the Cherokee Nation, TMG/OMECO Internal Medicine Residency Program
  • Stephen T. Bastible, D.O. TMG/OMECO Internal Medicine Residency Program https://orcid.org/0000-0001-6142-4809
  • Matthew W. Gibson, MS III OSU-CHS, Tulsa, OK
  • Jana Baker, D.O. OSU-CHS, VA Health Care System

Abstract

A 43-year-old kind lady presented to the clinic for rheumatological evaluation for chronic worsening joint pain and associated morning stiffness with family history of rheumatoid arthritis (RA) in her father and a daughter who is HLA-B27 positive. After initial clinic presentation, the patient was hospitalized for acute onset of a truncal skin rash which after biopsy was identified as being secondary to urticarial vasculitis (UV). Management consisted of oral methotrexate with discontinuation of previously initiated hydroxychloroquine (HCQ). While UV alone is not pathognomonic for lupus, patient-presentation both clinically and laboratory-wise favored systemic lupus erythematosus (SLE) (especially with presence of hypocomplementemia for C4) along with early rheumatoid arthritis(14.3.3η positivity), an overlapping condition also known as ‘rhupus’.

Author Biographies

Prashant Kaushik, M.D., Northeastern Health System, Oklahoma State University College of Osteopathic Medicine Center for Health Sciences at the Cherokee Nation, TMG/OMECO Internal Medicine Residency Program

Chief, Division of Rheumatology, Northeastern Health System (NHS), Tahlequah, OK; Clinical Associate Professor of Medicine, Oklahoma State University College of Osteopathic Medicine Center for Health Sciences (OSU CHS) at the Cherokee Nation, Tahlequah, OK. Associate Program Director, Internal Medicine Residency Program, TMG/OMECO.



Stephen T. Bastible, D.O. , TMG/OMECO Internal Medicine Residency Program

Department of Internal Medicine, PGY-2

Matthew W. Gibson, MS III, OSU-CHS, Tulsa, OK

OSU CHS, Tulsa, OK; MS-III

Jana Baker, D.O., OSU-CHS, VA Health Care System

Associate Professor, OSU CHS; previous Program Director of the TMG/OMECO Internal Medicine Residency Program; Division of Hospitalist Medicine at the Eastern Oklahoma VA Health Care System



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Published

2022-12-12

Issue

Vol. 6 No. 2 (2022): Article

Section

Medical

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