Pantic Ivana, Jevtic Djordje, Nordstrom Charles W, Madrid Cristian, Milovanovic Tamara, Dumic Igor
Clinic of Gastroenterology and Hepatology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
J Clin Med. 2022 Jan 29;11(3):739. doi: 10.3390/jcm11030739.
Leukocytoclastic vasculitis (LCV) is a rare extraintestinal manifestation (EIM) of ulcerative colitis (UC). Observations about its association with UC stem from case reports and small case series. Due to its rarity, more rigorous cross-sectional studies are scarce and difficult to conduct. The aim of this systematic review was to synthetize the knowledge on this association by reviewing published literature in the form of both case reports and case series; and report the findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In contrast to LCV in Chron disease (CD), which occurs secondary to biologic therapies used for its treatment, LCV in UC is a true reactive skin manifestation. Both genders are equally affected. Palpable purpura (41%) and erythematous plaques (27%) are the most common clinical manifestations. In 41% of patients, the rash is painful, and the lower extremities are most commonly involved (73%). Systemic symptoms such as fever, arthralgias, fatigue, and malaise are seen in 60% of patients. Unlike previous reports, we found that LCV more commonly occurs after the UC diagnosis (59%), and 68% of patients have active intestinal disease at the time of LCV diagnosis. Antineutrophil cytoplasmic antibody (ANCA) is positive in 41% of patients, and 36% of patients have other EIMs present concomitantly with LCV. The majority of patients were treated with corticosteroids (77%), and two (10%) required colectomy to control UC and LCV symptoms. Aside from one patient who died from unrelated causes, all others survived with their rash typically resolving without scarring (82%).
白细胞破碎性血管炎（LCV）是溃疡性结肠炎（UC）一种罕见的肠外表现（EIM）。关于其与UC关联的观察结果源于病例报告和小型病例系列。由于其罕见性，更严格的横断面研究稀缺且难以开展。本系统评价的目的是通过回顾以病例报告和病例系列形式发表的文献，综合关于这种关联的知识；并根据系统评价和Meta分析的首选报告项目（PRISMA）指南报告研究结果。与克罗恩病（CD）中的LCV不同，后者继发于用于治疗CD的生物疗法，UC中的LCV是一种真正的反应性皮肤表现。男女受影响程度相同。可触及的紫癜（41%）和红斑性斑块（27%）是最常见的临床表现。41%的患者皮疹有疼痛感，最常累及下肢（73%）。60%的患者出现发热、关节痛、疲劳和不适等全身症状。与既往报告不同，我们发现LCV更常见于UC诊断之后（59%），且68%的患者在LCV诊断时存在活动性肠道疾病。41%的患者抗中性粒细胞胞浆抗体（ANCA）呈阳性，36%的患者同时伴有其他肠外表现。大多数患者接受了糖皮质激素治疗（77%），两名患者（10%）需要行结肠切除术以控制UC和LCV症状。除一名患者死于无关原因外，其他所有患者均存活，其皮疹通常消退且不留瘢痕（82%）。
