Abstract：
Dialysis associated reactions presenting with urticarial vasculitis is rarely reported in medical literature. We report a 61-year-old gentleman who developed sudden onset dyspnea with diffuse erythema within 20 min of haemodialysis. Patient was started on Azilsartan 3 days prior to this clinical event. Labs revealed features of hemolysis and urine was positive for hemoglobinuria. All dialysis related factors responsible for this reaction were ruled out. Due to non-resolution of skin rash, skin biopsy was attempted which revealed fibrinoid necrosis of occasional vessels with predominant lymphocytic infiltration suggestive of drug induced urticarial vasculitis. Complement levels were normal. He was managed with steroids, anti-histaminic, discontinuation of azilsartan and change of dialyzer membrane. This case highlights a rare dermatological presentation of Type A dialysis associated reaction involving azilsartan with differential diagnosis and treatment strategies.
摘要：
在医学文献中很少报道与荨麻疹性血管炎有关的透析相关反应。我们报告了一名61岁的绅士，他在血液透析20分钟内出现了突发性呼吸困难伴弥漫性红斑。患者在该临床事件发生前3天开始服用阿齐沙坦。实验室显示溶血特征，尿液中血红蛋白尿呈阳性。排除了导致该反应的所有透析相关因素。由于不能解决的皮疹，尝试皮肤活检，发现偶尔血管的纤维蛋白样坏死，主要淋巴细胞浸润，提示药物引起的荨麻疹性血管炎。补体水平正常。他接受了类固醇治疗，抗组胺,停用阿齐沙坦和改变透析膜。此病例突出了涉及阿齐沙坦的A型透析相关反应的罕见皮肤病学表现，并具有鉴别诊断和治疗策略。
