Case Report: Elderly White Woman Presents with Recurrent Skin Lesions

Summary

We described a case of biopsy-proved RCEV that presented with punched, ulcerative skin lesions and no peripheral eosinophilia, both of which are unusual features rarely reported in the literature. RCEV is uncommon, but should remain on the differential diagnosis of necrotizing vasculitis with or without eosinophilia. Although prednisone was effective, the skin lesions recurred with prednisone taper, resulting in prolonged steroid use and multiple side effects.

Limited data exist to guide RCEV treatment, with only one case report of a patient successfully treated with tacrolimus, two with dapsone, one with indomethacin and one with suplatast tosilate.^5,7,8,15 Our patient did respond to azathioprine, suggesting its potential use in RCEV. Whether other immunosuppressive agents, such as mycophenolate or cyclophosphamide, would provide any benefit in severe cases remains unclear. 

Julia Tan, MD, is an internal medicine resident at the University of British Columbia, Vancouver, Canada.

Kun Huang, MD, PhD, is a rheumatologist at the University of British Columbia, Vancouver, Canada.

Natasha Dehghan, MD, is a rheumatologist at the University of British Columbia, Vancouver, Canada.

Neda Amiri, MD, is a rheumatologist at the University of British Columbia, Vancouver, Canada.

Acknowledgment: The authors thank Martin Trotter, MD, PhD, head of the Department of Pathology and Laboratory Medicine at Providence Health Care, University of British Columbia, Vancouver, Canada, for reviewing and preparing the histopathology images of this manuscript.

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