Urticaria Associated with Acute Viral Hepatitis Type B

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Abstract
To determine whether skin deposition of circulating immune complexes contributes to prodromal urticaria of acute hepatitis B, 2 patients with hepatitis B who presented with urticaria and fever were studied. During the urticarial prodrome but not thereafter, activation of classic and alternative complement[C] pathways was found. Hepatitis B surface antigen (HBsAg)-antibody complexes were identified (by EM) in cryoprecipitates from patients and Ig[immunoglobulin]G (by immunodiffusion) in cryoprecipitates of 1 patient during urticaria. Light microscopy and EM of involved urticarial skin revealed necrotizing venulitis in both patients. Immunofluorescence microscopy showed fibrin within involved cutaneous vessel walls in 1 patient and C3, IgM and HBsAg, which were not detected in simultaneously obtained uninvolved skin, in both patients. Deposition of circulating immune complexes containing HBsAg is probably important in the pathogenesis of urticaria associated with acute hepatitis B virus infection.