Cold urticaria with vasculitis: report of a case with light and electron microscopic, immunofluorescence and pharmacological studies

Abstract

An unusual form of essential acquired cold urticaria occurring in a 30‐year‐old woman is reported. Exposure of the skin to cold produced immediate wealing and angio‐oedema with subsequent deep bruising, and severe systemic symptoms. Light microscopic, ultrastructural and immunofluorescence studies of serial biopsies from the cold‐evoked skin lesions established a time course for the histological events occurring during the evolution of the inflammation. The appearance of complement (C3) in dermal blood vessels preceded the deposition of fibrin and immunoglobulin and obvious mast‐cell degranulation. These secondary changes accompanied a perivascular infiltrate of mixed inflammatory cells and lysis of both neutrophil and eosinophil leukocytes. Later, disruption of vascular endothclium was notable. Elevated histamine levels in venous blood draining a cold‐challenged limb indicated that histamine was released, possibly from skin mast cells, during the development of the urticaria.