Case Number : Case 1540 - 19 May Posted By: Guest

Wegener's?

This is clearly a systemic vasculitic disease and as Sasi asked, the next question should be what are the ANCA values of the patient and if there is any affection of renal function. We see an ulcer and compromise of medium sized vessels the differential for me is between granulomatosis with polyangeiitis vs eosinophilic granulomatosis with polyangeiitis. And as Sassi I favour Wegeners due to the absence of eosinophils and reference to asthma, eosinophilia, p-anca. If we saw compromise of small vessels (which I dont think is the case) other differentials could include connective tissue disease related vasculitis and microscopic polyangiitis.  

vasculitis more in favor of Wegener's. laboratory data such as serum c-ANCA can help.

although,in ulcerated skin lesions the diagnosis can be hard since secondary vasculitis can be found in the base of ulcers.

Epithelial necrosis and ulceration. A vasculitic process affecting the medium sized blood vessels, possibly a vague granuloma in the last image. Findings favouring Wegener's granulomatosis.

Agree too.

Indeed.  This is Wegener's.