VASCULITIS - PATIENT UNKNOWN
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 I have a 40yowm patient with biopsy proven vasculitis (type not
specified) on his hands.  These come and go over the past year.  They
itch but are otherwise asymptomatic.  He takes Atarax every other day
for Dermatographism and generalized pruritus.  He has contact
dermatitis-like eyelid rashes as well.  Basically, he is a healthy
hospital worker in management.  Pertinent medical history may be his
positive core antibody to Hep. B but negative surface antibody results.

 He denies any cardiac murmurs/problems, viral infections/ other causes
of vasculitis----i.e. Rheumatoid Arthritis or Lupus. ANA is pending and
CBC, General chemistries are reported to be normal.  Can Hep B core Ab
cause long lasting dermatographism?  If the ANA is negative, What
should be the next step?           

M. L. Burrow, M.D.    
Grd Jct.,CO
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A few small suggestions: Get the biopsy slide from his "vasculitis" and 
review it. 2. Consider a chronic subacute conatact derm with spread of 
antigen from the hands to the eyes 3. Dermatographism may be penecillin 
allergy. Penecillin is in milk products, sometime in chicken.4. Hep B 
antigenemia: check his sed rate and cryoglobulins. If these are normal 
the hepatitis antigen probably isnt the culprit.5. If you want to give 
him a respite try dexamethasone 0.75mg po qam for 20 days... it will stop 
the symptoms (for a while) and make him think you're on the right track 
(while you're figuring out whats wrong) 

Haines Ely MD 
Grass Valley, Ca.
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Assuming the Hep B core Ab result is not a false positive (you might at 
least repeat the Hep B workup, perhaps with a different lab) then if 
it's still positive I might suspect he's in the prodromal or subclinic 
phase of a Hep B infection. Urticarial vasculitis, vasculitis and 
polyarteritis nodosa can all be associated. Alternatively, he might just 
be an atopic with rashes, but vasculitis doesn't really fit in well with 
that notion, nor a positive test for hepatitis. If he is Hep B positive, 
you might also be excused for wondering if he's HIV positive.

Mark Naylor, M.D.
Center for Molecular Medicine
University of Oklahoma Health Sciences Center
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				4.24.96

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				4.24.96