1. CHRONIC URTICARIA ASSOCIATED WITH HYPERURICEMIA- A CASE REPORT Authors: Burdun Oana-Cristiana, Rab Andrea, Sala Nicoleta Coordinators: Sef lucrari Dr. Ureche Corina, Conf. Dr. Bancu Ligia Presented by: Rab Andrea

2. Introduction Urticaria (hives) appears as raised, well-circumscribed areas of erythema and edema involving the dermis and epidermis that are very pruritic.  Acute < 6 weeks  Chronic > 6 weeks Etiology is known in ◦ 40-60% in the case of acute urticaria ◦ 10-20% in the case of chronic urticaria Chronic urticaria can be caused and maintained by a large number of different factors.

3. Materials and Methods 56 years old male patient Past medical history ◦ Edematous pancreatitis (June 2013) ◦ Multiple urticarial episodes  debuted 3 months before hospitalization  Initial treatment included second-generation antihistamines and oral corticosteroids smoking, regular alcohol consumption At the presentation: ◦ Treatment with oral CS, second-generation antihistamines ◦ Generalized urticarial lesions and facial angioedema (approximately for 3 days)

4. HivesAngioedema

5. Paraclinical investigations Laboratory tests:  Glycemia = 95mg%  Erythrocyte sedimentation rate 1h = 5mm/h (NV=3-9mm/h)  Fibrinogen = 327mg% (NV=150-400mg%)  Anti-HCV antibody = negative  Ag HBs = negative  VDRL = negative  CICs = 8.72ug Eq/ml (negative<16 Eq/ml)  IgG anti-Toxoplasma pondii = positive  Serum IgE = 35UI (NV<100)  ANA screening = negative  TSH and Ft4 = Normal Abdominal ecography and CT-scan= without any pathological change

6. Treatment Desloratadine 4x5 mg/day p.o. Rovamycine 2x3 mil/day p.o. i.v. CS therapy No improvement Mild improvement Evolution Gout attack with the inflammation of the metatarsophalangeal joints bilaterally Serum uric acid level= 9.9 mg% (NV<5.7mg%) Treatment : initially NSAID, after that Allopurinol 3x100mg (8 days) Disappearance of both the articular inflammation and the urticarial rashes

8. Hospital discharge Treatment: Allopurinol 100 mg/day and 2- generation antihistamines. Favorable outcome

9. Discussion and conclusion Particularity of the case: Adult male patient, after an episode of acute pancreatitis urticarial lesions appeared, which were later associated with facial angioedema and acute gouty arthritis (after aproximatly 3 months) There are no studies in the literature to underline a particular relation between hyperuricemia and chronic urticaria We tend to think that in this case urticarial lesions appeared as a consequence of increased serum uric acid levels.

10. Thank You!