Case Report

Cutaneous Ulcers as Initial Presentation of Localized Granulomatosis with Polyangiitis: A Case Report and Review of the Literature

Table 2

Case reports of localized GPA with cutaneous manifestations.

Author and year of publicationDiagnosisOrgan involvementANCAClinical course

Kihiczak et al. [13]
1994
Protracted superficial GPASkin, nasal mucosaN/AProtracted course characterized by granulomatous skin and nasal ulcers

Figarella et al. [14]
2000
Protracted superficial GPAUpper respiratory tract, skin, and lungN/ASkin nodules on leg present for 10 years, before the diagnosis was established based on cutaneous histopathology

Brazzelli et al. [32] 
1999
Cutaneous GPAAcneiform nodular and popular eruption on forehead, dense pulmonary infiltratesPositiveNecrotic ulcers on forearms, arms, and buttocks, small vessel vasculitis of deep dermis

Kuchel and Lee [21]
2003
Cutaneous GPASkin involving ear lobe, ankles, and feetNegativeResponded to prednisone and CYC, granulomatous inflammation on biopsy

Sinovich and Snow [33]
2003
Protracted superficial GPAInfra-auricular skin and nasal mucosaPositivePyoderma gangrenosum like lesions with suppurative granulomatous inflammation. Responded to prednisone and azathioprine

Kawakami et al. [34]
2005
GPA with cutaneous leukocytoclastic vasculitisSkin, lung, and kidneyPositiveVarious cutaneous manifestations. Palisading neutrophilic granulomatous dermatitis on histopathology

Ben Ghorbel et al. [35]
2007
Cutaneous and mucosal GPA as initial presentation in an adultTongue and labial ulcers, digital necrosis, splinter hemorrhages of fingernails, and purpuraPositiveDiagnosis confirmed on cutaneous and renal biopsies. Resolution of cutaneous disease after 6 weeks of treatment with prednisone and CYC

Ben Ghorbel et al. [15]
2007
Recurrent digital necrotic ulcers on fingers, toes, and scapula as cutaneous GPA in a childNasal mucosa, eyes (keratitis), and skinPositiveSuperficial ulcerations with granulomatous vasculitis

Thaiwat and Aunhachoke [22]
2010
Superficial GPA with chronic scalp ulcerSkinNegativeSolitary nodule on scalp with alopecia; nodules on left arm and shin; purpura