{"title":"Circumferential Eschar-Covered Necrotic Leg Ulcers in a Case of Granulomatous Vasculitis: Looking Beyond ANCA Serology.","authors":"Shilpi Tyagi, Shubham Kumar, Afroz Alam, Deepak Vedant, Saurabh Singh","doi":"10.1097/DAD.0000000000002929","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>Cutaneous vasculitis, either as a single organ or part of systemic vasculitis, can take various forms. Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation in the respiratory tract and vasculitis affecting small- to medium-sized blood vessels. Skin-limited GPA, an uncommon presentation, poses diagnostic challenges and may result in delayed diagnosis. We describe a 32-year-old man with painful ulcers and black eschars on both lower limbs, evolving from purpura. Despite lacking typical anti neutrophil cytoplasmic antibodies and systemic involvement, histopathology revealed granulomatous vasculitis. Treatment with prednisolone and methotrexate led to complete symptom resolution within 8 months. Skin-limited GPA, often without anti neutrophil cytoplasmic antibody positivity, warrants clinical suspicion, early intervention, and increased awareness to enhance patient outcomes.</p>","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":"308-310"},"PeriodicalIF":1.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Dermatopathology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/DAD.0000000000002929","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/6 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract: Cutaneous vasculitis, either as a single organ or part of systemic vasculitis, can take various forms. Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation in the respiratory tract and vasculitis affecting small- to medium-sized blood vessels. Skin-limited GPA, an uncommon presentation, poses diagnostic challenges and may result in delayed diagnosis. We describe a 32-year-old man with painful ulcers and black eschars on both lower limbs, evolving from purpura. Despite lacking typical anti neutrophil cytoplasmic antibodies and systemic involvement, histopathology revealed granulomatous vasculitis. Treatment with prednisolone and methotrexate led to complete symptom resolution within 8 months. Skin-limited GPA, often without anti neutrophil cytoplasmic antibody positivity, warrants clinical suspicion, early intervention, and increased awareness to enhance patient outcomes.
期刊介绍：
The American Journal of Dermatopathology offers outstanding coverage of the latest diagnostic approaches and laboratory techniques, as well as insights into contemporary social, legal, and ethical concerns. Each issue features review articles on clinical, technical, and basic science advances and illuminating, detailed case reports.
With the The American Journal of Dermatopathology you''ll be able to:
-Incorporate step-by-step coverage of new or difficult-to-diagnose conditions from their earliest histopathologic signs to confirmatory immunohistochemical and molecular studies.
-Apply the latest basic science findings and clinical approaches to your work right away.
-Tap into the skills and expertise of your peers and colleagues the world over peer-reviewed original articles, "Extraordinary cases reports", coverage of practical guidelines, and graphic presentations.
-Expand your horizons through the Journal''s idea-generating forum for debating controversial issues and learning from preeminent researchers and clinicians
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