Document Type : Case Report


1 Dayanand Medical College & Hospital, Ludhiana, Punjab, India

2 Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India


Rheumatoid vasculitis, an uncommon extraarticular manifestation
of rheumatoid arthritis, usually develops in long-standing cases
affecting small-to-medium-sized vessels. It is a poor prognostic
marker when multiple systems are affected, skin and neurologic
involvement being most frequent. Rheumatoid vasculitis is seen
more commonly in seropositive and nodular rheumatoid arthritis
patients who are male or smoke. Herein, we present the peculiar
case of a 48-year-old female with rapid onset, progressive, multiple
ulcers predominantly over the flexures. Differential diagnoses of
pyoderma gangrenosum, pyoderma vegetans, pemphigus vegetans,
and vasculitis were considered, and the patient was evaluated. On
investigation, her rheumatoid factor titer was strongly positive;
a skin biopsy revealed leukocytoclastic vasculitis. On clinical,
serological, and histopathological correlation, a diagnosis of
rheumatoid vasculitis was made, responding well to high-dose
prednisolone. On follow-up at six months, her skin lesions had
healed well with moderate scarring; however, she developed
severe joint pain, warranting the initiation of disease-modifying
antirheumatic drugs. To the best of our knowledge, this is a
previously unreported clinical and morphological presentation
of rheumatoid vasculitis.