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Patient Case: Urticaria

Patient Case: Urticaria

Discussion

A 30-year-old man presents to the clinic with a 24-hour history of itchy, red, raised welts that appeared suddenly on his arms, chest, and back. He describes the lesions as coming and going, lasting for a few hours before fading, only to reappear in different areas. He denies any fever, respiratory distress, or other systemic symptoms but reports mild facial swelling.

He recently started taking ibuprofen for a mild headache and ate a seafood dish he had never tried before. He denies any known allergies, previous similar reactions, or chronic medical conditions.

On examination, multiple erythematous, blanching wheals are present on his trunk and upper limbs. There is no angioedema of the throat or tongue, and his vital signs are stable. A clinical diagnosis of acute urticaria is made, likely triggered by a medication or food allergen.

He is treated with oral antihistamines, advised to avoid potential triggers, and given an epinephrine auto-injector in case of worsening symptoms. He is also referred for an allergy evaluation to determine the specific cause.

Questions
1. What is the most likely diagnosis in this patient?

a) Atopic dermatitis
b) Urticaria
c) Contact dermatitis
d) Psoriasis

2. What is the most likely trigger for this patient’s condition?

a) A bacterial skin infection
b) A new seafood dish or ibuprofen
c) Chronic exposure to sunlight
d) Deficiency of essential fatty acids

3. What is the most appropriate initial treatment for this patient?

a) Oral antihistamines and avoidance of triggers
b) Systemic corticosteroids for long-term management
c) Topical antifungals and antibiotics
d) Immunosuppressive therapy

4. Which of the following symptoms would indicate a medical emergency in this patient?

a) Increased itching and additional skin lesions
b) Mild swelling of the fingers
c) Difficulty breathing and throat swelling
d) Nausea and mild abdominal discomfort

Reveal answers

Answers

  1. (b) Urticaria
    • The sudden onset of itchy, red, raised wheals that appear and disappear in different areas is classic for urticaria. Atopic dermatitis (a) is chronic and usually involves dry, scaly patches, contact dermatitis (c) has a specific exposure-related pattern, and psoriasis (d) presents with well-defined plaques and silvery scaling.
  2. (b) A new seafood dish or ibuprofen
    • Acute urticaria is commonly triggered by allergens, including certain foods, medications (like NSAIDs), infections, or insect bites. Bacterial infections (a) are not a primary cause, sun exposure (c) is more related to conditions like solar urticaria, and nutrient deficiencies (d) do not cause acute urticaria.
  3. (a) Oral antihistamines and avoidance of triggers
    • Antihistamines are the first-line treatment for urticaria, and trigger avoidance helps prevent recurrence. Systemic corticosteroids (b) are used in severe cases but are not the first-line treatment. Antifungals and antibiotics (c) are unnecessary, and immunosuppressants (d) are not indicated.
  4. (c) Difficulty breathing and throat swelling
    • Throat swelling and difficulty breathing indicate angioedema or anaphylaxis, which is a medical emergency requiring epinephrine. Increased itching and additional lesions (a) are common but not life-threatening. Mild finger swelling (b) and nausea (d) may be concerning but are not immediate emergencies.

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