Case Report: Upadacitinib in the management of refractory urticarial vasculitis

Urticarial vasculitis (UV) is a rare autoimmune condition characterized by persistent urticarial lesions with underlying small vessel leukocytoclastic vasculitis. It often presents with systemic symptoms and poses therapeutic challenges, especially in refractory cases. We report the case of a 39-yea...

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Main Authors: Maan M. Almaghrabi, Nadeen Kalantan, Alhusain Alshareef, Abdulhadi Jfri
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1669513/full
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author Maan M. Almaghrabi
Maan M. Almaghrabi
Nadeen Kalantan
Nadeen Kalantan
Alhusain Alshareef
Abdulhadi Jfri
Abdulhadi Jfri
Abdulhadi Jfri
author_facet Maan M. Almaghrabi
Maan M. Almaghrabi
Nadeen Kalantan
Nadeen Kalantan
Alhusain Alshareef
Abdulhadi Jfri
Abdulhadi Jfri
Abdulhadi Jfri
author_sort Maan M. Almaghrabi
collection DOAJ
description Urticarial vasculitis (UV) is a rare autoimmune condition characterized by persistent urticarial lesions with underlying small vessel leukocytoclastic vasculitis. It often presents with systemic symptoms and poses therapeutic challenges, especially in refractory cases. We report the case of a 39-year-old woman who presented with recurrent episodes of widespread, painful wheals lasting more than 24 h, along with arthralgia, myalgia, blurred vision, and fatigue. Her diagnosis was confirmed by skin biopsy, and she failed multiple lines of immunosuppressive and biologic therapies, including corticosteroids, colchicine, omalizumab, dapsone, rituximab, mycophenolate mofetil, and cyclosporine. After initiating treatment with Upadacitinib 30 mg daily orally, in combination with omalizumab and dapsone, she experienced a dramatic clinical improvement within one month, with near-complete resolution of cutaneous lesions and significant relief of systemic symptoms. This case highlights the potential role of JAK inhibitors, particularly Upadacitinib, as a novel therapeutic option in managing refractory urticarial vasculitis. Further studies are needed to evaluate its long-term efficacy and safety in this context.
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institution Kabale University
issn 2296-858X
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publishDate 2025-08-01
publisher Frontiers Media S.A.
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spelling doaj-art-3c2db8f3eb5d4efb86d270ce6b7fb9eb2025-08-26T04:12:48ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-08-011210.3389/fmed.2025.16695131669513Case Report: Upadacitinib in the management of refractory urticarial vasculitisMaan M. Almaghrabi0Maan M. Almaghrabi1Nadeen Kalantan2Nadeen Kalantan3Alhusain Alshareef4Abdulhadi Jfri5Abdulhadi Jfri6Abdulhadi Jfri7College of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaDivision of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi ArabiaDivision of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi ArabiaDepartment of Rheumatology, The Ottawa Hospital, Ottawa, ON, CanadaDivision of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi ArabiaDivision of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi ArabiaCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi ArabiaKing Abdullah International Medical Research Center, Jeddah, Saudi ArabiaUrticarial vasculitis (UV) is a rare autoimmune condition characterized by persistent urticarial lesions with underlying small vessel leukocytoclastic vasculitis. It often presents with systemic symptoms and poses therapeutic challenges, especially in refractory cases. We report the case of a 39-year-old woman who presented with recurrent episodes of widespread, painful wheals lasting more than 24 h, along with arthralgia, myalgia, blurred vision, and fatigue. Her diagnosis was confirmed by skin biopsy, and she failed multiple lines of immunosuppressive and biologic therapies, including corticosteroids, colchicine, omalizumab, dapsone, rituximab, mycophenolate mofetil, and cyclosporine. After initiating treatment with Upadacitinib 30 mg daily orally, in combination with omalizumab and dapsone, she experienced a dramatic clinical improvement within one month, with near-complete resolution of cutaneous lesions and significant relief of systemic symptoms. This case highlights the potential role of JAK inhibitors, particularly Upadacitinib, as a novel therapeutic option in managing refractory urticarial vasculitis. Further studies are needed to evaluate its long-term efficacy and safety in this context.https://www.frontiersin.org/articles/10.3389/fmed.2025.1669513/fullurticarial vasculitisUpadacitinibJAK inhibitordermatologyrheumatology
spellingShingle Maan M. Almaghrabi
Maan M. Almaghrabi
Nadeen Kalantan
Nadeen Kalantan
Alhusain Alshareef
Abdulhadi Jfri
Abdulhadi Jfri
Abdulhadi Jfri
Case Report: Upadacitinib in the management of refractory urticarial vasculitis
Frontiers in Medicine
urticarial vasculitis
Upadacitinib
JAK inhibitor
dermatology
rheumatology
title Case Report: Upadacitinib in the management of refractory urticarial vasculitis
title_full Case Report: Upadacitinib in the management of refractory urticarial vasculitis
title_fullStr Case Report: Upadacitinib in the management of refractory urticarial vasculitis
title_full_unstemmed Case Report: Upadacitinib in the management of refractory urticarial vasculitis
title_short Case Report: Upadacitinib in the management of refractory urticarial vasculitis
title_sort case report upadacitinib in the management of refractory urticarial vasculitis
topic urticarial vasculitis
Upadacitinib
JAK inhibitor
dermatology
rheumatology
url https://www.frontiersin.org/articles/10.3389/fmed.2025.1669513/full
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