Neutrophilic Urticarial Dermatosis Accompanied with Bullous Lesions

Abstract

Neutrophilic urticarial dermatosis (NUD) clinically resembles urticaria but histopathologically represents a neutrophilic dermatoses. Affected patients develop erythematous macules, papules or slightly raised plaques lasting 24 to 48 hours. Histopathologic examination reveals an intense neutrophilic infiltration in the dermis with leukocytoclasia, but without fibrinoid necrosis of vessel walls. Clinical manifestations of NUD are similar to urticaria or Sweet’s syndrome, but it differs in that accompanying systemic symptoms like fever or arthralgia, and histologic features of dense neutrophilic infiltration in the dermis. A 69-year-old female patient presented with a one-day history of pruritic skin rashes and fever. Skin rashes appear erythematous patches and plaques on the whole body accompanied with multiple vesiculobullous lesions on both lower legs. Skin biopsy of lesion displayed interstitial neutrophilic infiltration in Indian file between collagen fiber, and leukocytoclasia. There were no clinical and laboratory findings that suspect of associated diseases. Herein, we report the first case of NUD developing vesiculobullous lesions.