Urticaria and Arthralgias as Manifestations of Necrotizing Angiitis (Vasculitis)**From the Departments of Dermatology and Medicine. Harvard Medical School, and the Division of Dermatology, Departments of Medicine, Peter Bent Brigham and Robert B. Brigham Hospitals. Boston, Massachusetts. (Reprint requests to: Dr. Soter, Robert B. Brigham Hospital, 125 Parker Hill Avenue, Boston, Mass. 02120.)

Although necrotizing angiitis (vasculitis) of the superficial venules and capillaries of the skin is usually appreciated visually as a purpuric papule, a group of patients has been defined in whom all of the skin lesions were urticarial. Microscopic examination of skin biopsy specimens showed fibrinoid necrosis of the blood-vessel walls, an infiltrate containing polymorphonuclear leukocytes, fragmentation of cell nuclei, and extravasation of erythrocytes. Arthralgias were present in 7 of the 8 patients and arthritis in 3 of these. Two of the patients experienced episodes of abdominal pain. A syndrome of chronic refractory urticaria accompanied by arthralgias and occasionally arthritis or abdominal pain and an elevated erythrocyte sedimentation rate was recognized in nonatopic female patients and appears to be a manifestation of an underlying necrotizing angiitis