Urticarial Vasculitis: A Case Report of Comorbid Generalized Anxiety Disorder

TL;DR

A 29-year-old woman with generalized anxiety disorder developed urticarial vasculitis after psychological stress, responding well to corticosteroids.

Contribution

This case report highlights the association between psychological stress and urticarial vasculitis in a patient with generalized anxiety disorder.

Findings

The patient's symptoms included a purpuric rash, gastrointestinal discomfort, arthralgia, and myalgia.

Antihistamines were ineffective, but oral corticosteroids provided significant improvement.

The case suggests psychological stress may trigger urticarial vasculitis in individuals with psychiatric comorbidities.

Abstract

Urticarial vasculitis (UV) is a rare small-vessel vasculitis that can mimic chronic spontaneous urticaria but is distinguished by longer-lasting, painful lesions and potential systemic involvement. We present the case of a 29-year-old woman with untreated generalized anxiety disorder (GAD) who developed a painful, purpuric rash following a period of intense psychological stress and prolonged sedentary behavior while engaged in academic duties. Her symptoms included gastrointestinal discomfort, arthralgia, and myalgia. Laboratory investigations revealed normal inflammatory markers, normal complement levels, and negative autoimmune serologies, consistent with a diagnosis of normocomplementemic urticarial vasculitis (NUV). Antihistamines were ineffective; however, the patient responded well to oral corticosteroids. This case emphasizes the need to consider NUV in the differential diagnosis of persistent urticarial lesions with systemic symptoms and poor response to antihistamines. It also highlights the potential role of psychological stress as a trigger, particularly in individuals with comorbid psychiatric conditions such as GAD. A multidisciplinary approach integrating dermatologic, immunologic, and psychological evaluation is essential for optimal management.

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