Leucocytoclastic vasculitis presenting as an erythema gyratum repens-like eruption

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Abstract

Conflict of interest: the authors declare that they have no conflicts of interest. We present the case of a 57‐year‐old woman with a 10‐year history of antineutrophil cytoplasmic antibody (ANCA)‐negative systemic vasculitis characterized by urticarial vasculitis, arthritis and livedo reticularis. The disease was poorly controlled on prednisolone, tacrolimus and hydroxychloroquine, and previous treatment with mycophenolate mofetil, methotrexate and cyclophosphamide had failed to control it. The patient presented acutely with myalgia, arthralgia and a flare of urticarial vasculitis. Blood results showed a C‐reactive protein level of 24.5 mg/dL (normal level < 10 mg/dL). The skin eruption evolved rapidly and was associated with abdominal pain. The pattern of urticarial vasculitis lesions began to change dramatically, with large nonscaly concentric erythematous coalescing rings over the lower legs, surrounded by a purple purpuric halo with a cockade configuration of the lesion margins (Fig 1a,b) Given the erythema gyratum repens (EGR)‐like pattern (although it did not migrate with a trailing edge as would be seen classically), computed tomography of the chest, abdomen and pelvis was requested in view of the continued abdominal pain. The scans suggested the possibility of a sigmoid perforation. The patient underwent an urgent abdominal laparoscopy but no perforation or malignancy was identified.

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