Non-itching urticaria-like lesions with transient myalgia in a father and his son in long-term observation

Non-itching urticaria-like lesions with transient myalgia in a father
and his son in long-term observation

The aim of this letter is to report a case of recurrent urticaria-like lesions with myalgia occurring after a common cold-like infection in a father and his son. The disease has been observed by one of us (EJK) for more than 35 years.
The 61-year-old male patient suffers from urticaria-like cutaneous changes occurring after a common cold-like infection. He has the disease usually 1–3 times per year. The infection is typical for so-called “overcooling” and is characterized by a running nose, increased body temperature and pharyngeal irritation. These common symptoms are associated in the patient with myalgia affecting the proximal muscles of the limbs and significant low back pain. The occurrence of muscular pain is always associated with urticaria-like lesions. They consist of non-elevated dark purple spots with rather clear borders and without traces of subcutaneous bleeding. They affect only the trunk, upper limbs and inguinal region. The face, hands and lower limbs are not affected. Cutaneous lesions are otherwise asymptomatic. They appear usually during the night and are discovered in the morning during body washing. They are preceded by one-two days of fatigue and “feeling of common cold initial symptoms” and myalgia appears usually in the afternoon or evening a day before the night appearance of the cutaneous lesions. There is no itching, swelling, burning or other symptoms to be recorded by the patient. He discovered the urticarial lesions incidentally, but after a few relapses he expects skin involvement. The disease is self-limiting and disappears completely within 3–4 days. Myalgia usually disappears earlier. It is of interest that cutaneous lesions disappear even if general symptoms of common cold-like disease lasted longer (Fig. 1).
The described patient was otherwise healthy. He has seasonal hay fever but the reported skin involvement is not related to hay fever or to any part of the year.
The same clinical picture was observed by one of us (EJK) in the patient’s father. He suffered from the above-described urticaria-like lesions with myalgia according to his medical history for at least 40 years. He died a few years ago due to myocardial infarction at the age of 82. In his last five years of life he suffered from arthritis akin to rheumatoid arthritis with rapid development of joint malformations.
The young patient has one daughter. She has some non-itching cutaneous changes but they appear to be unrelated to common cold infections, and without myalgia. The nature of the urticaria-like alterations remains unknown. It is possible that both skin and muscle involvement result from viral infections. Transient rash or other skin lesions are common symptom of various viral infections. The above-described symptoms are not a form of allergy and it can be hypothesized that they are caused by an inborn deficiency of unknown nature (e.g. components of the complement system).
From the practical point of view, it is important to remember such forms of reactivity to infection and include them in the differential diagnostics.

Eugeniusz J. Kucharz, Anna Kotulska