case_images: PMC11807357_01
case_images: Clinical presentation on the first visit to our department. (a) Red bean-sized edematous erythematous spots scattered on the trunk. (b) Scattered edematous erythematous patches on the right thigh ranging from the size of the thumb to the size of a walnut. (c) Part of the right foot with annular erythema. Each rash gradually expanded to the size of the palm over several days and disappeared after 7-10 days.
case_images: JDE-52-344-g002.jpg
case_images: PMC11807357_01_JDE-52-344-g002.jpg
case_images: jde17480-fig-0001
case_images: On initial examination, bean-sized edematous erythematous patches (Figure 1a) were observed on the trunk. Edematous erythema grew up to the size of the palm and some with annular erythema were also scattered on his extremities (Figure 1b,c).
case_images: A biopsy was performed from an edematous erythema on the right lower leg. No significant changes in the epidermis were observed. Moderate lymphocytic infiltration and edema in the perivascular and interstitial areas of the superficial dermis were noted, and a few eosinophils were found, but no nuclear dust or fibrinoid degeneration of the vessel wall was found.
case_images: JDE-52-344-g003.jpg
case_images: PMC11807357_01_JDE-52-344-g003.jpg
case_images: jde17480-fig-0002
case_images: However, no findings suggestive of vasculitis, such as nuclear dust or fibrinoid degeneration of the vessel wall, were observed (Figure 2).
case_images: Clinical course after the start of treatment. The severity of urticaria was expressed using the severity level listed in the Japanese guideline for urticaria management. These severity levels are as follows: 5, unable to have a social life; 4, barely able to live with disabilities; 3, the discomfort is tolerable; 2, symptoms that are not noticeable; 1, no symptoms. With oral betamethasone and cyclosporine, the number of wheals reduced and the pruritus disappeared. Five months after the initial visit, the patient's urticaria was declared to be cured.
case_images: JDE-52-344-g001.jpg
case_images: PMC11807357_01_JDE-52-344-g001.jpg
case_images: jde17480-fig-0003
case_images: His clinical course is shown in Figure 3.