Case Number : CASE 4208 - 08 March 2023 Posted By: Dr. Hafeez Diwan

Very difficult and intriguing case. Leucocytoclastic vasculitis, but with dramatic trombotic component and some lamellar collagen:

? 1) early phase of GF 

? 2) post-Covid19-vaccination vasculitis

But am afraid I'm off track. Waiting for the sentence. 

Thrombotic vasculopathy leading to necrosis. ? cryoglobulinemia

Granulomatosis with Polyangitis, formerly wegners granulomatosis. The second Differential is Microscopic Polyangiitis There are PMN in the vessel wall with fibrin deposits. So it satisfies the criteria for vasculitis. Now to me, it looks like there are a few epithelioid cells centered around vessels. The thrombosis is probably a secondary phenomenon. This, together with the clinical picture points towards Wegners Granulomatosis (Or nowadays called GPA, Granulomatosis with Polyangiitis)

Vascular occlusive disease. 

Thrombotic vasculopathy. Extensive work-up was performed. Cryoglobulins were negative. There is no history of drug use.