595 Urticarial Rash Associated with Chest Pain

BACKGROUND: Urticaria may be the first manifestation of an underlying systemic disease (tumors, infections, collagen vascular or thyroid disease. Differential diagnosis must be made with many entities that can be manifested with a similar skin injury. METHODS: A 49 year-old man who during 2 years has monthly multi-days episodes of generalized pruritic papular skin lesions, responding to steroids but not to antihistamines. Occasionally associated with joint pain. Two skin injuries biopsies informed of simple urticaria. One year after skin lesion onset, he began with chest pain episodes suggestive of angina pectoris with elevated necrosis enzyme markers and ischemic changes on EKG. Angina episodes were sometimes preceded by skin lesion outbreak and it responded to steroid. Coronary catheterization was negative twice, so the diagnosis was vasospastic angina. Later he presented cough, wheezing, elevation of transaminases, LDH, FA, GGT, CPR and fibrinogen, 800 eosinophils in peripheral blood. Sputum eosinophils 40 to 60%.Chest X-Ray objective a thickened left hilum and doubtful left parahilar infiltrated. RESULTS: Allergologic study—Skin prick test with aeroallergens and wide food battery were negative. Specific IgE against Anisakis, latex, Echinococcus and other blood parameters including serology, autologous patient serum skin test were all normal/negative. Tryptase determination at baseline and during skin lesion shoot: normal. Other explorations—ECO-cardio: inferior basal akinesia and inferoposterior hypokinesia, LVEF 60%, normal RV systolic function and valves. CT scan visualize mediastinal and abdominal adenopathy, splenomegalia and ureterolithiasis. Mediastinoscopy and biopsy of right paratracheal grainy adenopathy confirms the diagnosis of sarcoidosis. ACE: 250 U/L. Gallium67 scan suggestive mediastinal sarcoidosis. Heart RM scan: no evidence of morphological criteria for cardiac sarcoidosis diagnosis. CONCLUSIONS: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. It may affect almost any organ, predominantly lung, lymph nodes and skin. Cardiac involvement is 25% but only symptomatic in 5%. We report a patient with sarcoidosis and vasoespastic angina. It´s described cases of cardiac sarcoidosis and vasospastic angina. In this case we cannot demonstrate cardiac injury. Sarcoidosis is a great simulating of cutaneous lesions and it can imitate to urticaria.