Pyoderma gangrenosum-like ulcerations in granulomatosis with polyangiitis: two cases and literature review

Giovanni Genovese, Simona Tavecchio, Emilio Berti, Franco Rongioletti, Angelo Valerio Marzano

Research output: Contribution to journalReview articlepeer-review

Abstract

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing small vessel vasculitis associated with circulating anti-neutrophil cytoplasmic antibodies (ANCAs). Skin manifestations, mostly represented by palpable purpura, papulonodular lesions and livedo reticularis, are present in up to 50% of the cases. Ulcerations with undermined, raised erythematous–violaceous border resembling pyoderma gangrenosum (PG) have rarely been reported as skin involvement in GPA. The presence of circulating ANCAs with a cytoplasmic labelling pattern, the involvement of internal organs, particularly of the lung, and the absence on histology of a mainly neutrophilic infiltrate in early phases of the cutaneous lesions may be regarded as clues to rule out true PG and confirm the diagnosis of GPA skin ulcerations simulating PG. Herein, we describe two paradigmatic cases of such a unique presentation of GPA and a literature review focusing on clinicopathological features of GPA presenting with PG-like ulcerations in the skin has been provided. Moreover, referring to the scenario observed in these two cases, an easy-to-use working approach for the differential diagnosis between the two conditions has also been proposed.

Original languageEnglish
Pages (from-to)1139-1151
Number of pages13
JournalRheumatology International
Volume38
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Keywords

  • ANCA-associated vasculitis
  • Granulomatosis with polyangiitis
  • Pyoderma gangrenosum

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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