Nonpruritic Urticaria: A Sign of Serious Systemic Disease

A 51-year-old woman developed a nonpruritic urticated rash following a COVID-19 infection, which led to a diagnosis of systemic lupus erythematosus (SLE) with associated symptoms including pericarditis, hypertension, and renal impairment. Histopathology and serology indicated possible neutrophilic urticarial dermatosis (NUD) or hypocomplementemic urticarial vasculitis syndrome (HUVS). The patient later experienced central nervous system vasculitis, treated successfully with methylprednisolone, intravenous immunoglobulin, and plasma exchange. This case underscores the importance of considering serious systemic diseases in patients with nonpruritic urticated rashes and highlights the need for comprehensive serological testing and biopsy for accurate diagnosis and early treatment.