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CASE REPORT article

Front. Med.

Sec. Dermatology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1669513

Case Report: Upadacitinib in the Management of Refractory Urticarial Vasculitis

Provisionally accepted
Maan AlmaghrabiMaan Almaghrabi1,2*Nadeen KalantanNadeen Kalantan1,3Alhussain AlshareefAlhussain Alshareef1Abdulhadi JfriAbdulhadi Jfri1,4,5
  • 1Division of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia
  • 2King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia
  • 3Department of Rheumatology, The Ottawa Hospital, Ottawa, Canada, Ottawa, Canada
  • 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia
  • 5King Abdullah International Medical Research Center, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia

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Urticarial vasculitis (UV) is a rare autoimmune condition characterized by persistent urticarial lesions with underlying small vessel leukocytoclastic vasculitis. It often presents with systemic symptoms and poses therapeutic challenges, especially in refractory cases. We report the case of a 39-year-old woman who presented with recurrent episodes of widespread, painful wheals lasting more than 24 hours, along with arthralgia, myalgia, blurred vision, and fatigue. Her diagnosis was confirmed by skin biopsy, and she failed multiple lines of immunosuppressive and biologic therapies, including corticosteroids, colchicine, omalizumab, dapsone, rituximab, mycophenolate mofetil, and cyclosporine. After initiating treatment with Upadacitinib 30 mg daily orally, in combination with omalizumab and dapsone, she experienced a dramatic clinical improvement within one month, with near-complete resolution of cutaneous lesions and significant relief of systemic symptoms. This case highlights the potential role of JAK inhibitors, particularly Upadacitinib, as a novel therapeutic option in managing refractory urticarial vasculitis. Further studies are needed to evaluate its longterm efficacy and safety in this context.

Keywords: Urticarial Vasculitis1, Upadacitinib2, JAK inhibitor3, Dermatology4, rheumatology5

Received: 19 Jul 2025; Accepted: 12 Aug 2025.

Copyright: © 2025 Almaghrabi, Kalantan, Alshareef and Jfri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Maan Almaghrabi, Division of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia, Jeddah, Saudi Arabia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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