Urticarial vasculitis, immune complex disease, and an infected ventriculoatrial shunt

Shunt nephritis syndrome consists of glomerulonephritis, mixed cryoglobulinemia, and persistent bacteremia. A 37-year-old woman with a prior history of a ventriculoatrial shunt presented complaining of urticaria. A skin biopsy specimen from one lesion showed findings consistent with vasculitis. Because microscopic hematuria was seen on urinalysis, systemic disease was suspected. The ensuing diagnostic workup revealed the syndrome of "shunt nephritis." To our knowledge, cutaneous findings of urticaria and vasculitis have not been previously reported in this interesting syndrome.