# A Unique Case of Granulomatosis With Polyangiitis With Cutaneous Manifestations Developing a Decade Later

## TL;DR

A man with granulomatosis with polyangiitis (GPA) developed skin symptoms over a decade after his initial diagnosis, highlighting the variable and delayed nature of GPA's cutaneous manifestations.

## Contribution

This case report highlights the rare occurrence of delayed cutaneous manifestations in GPA, expanding clinical awareness of its variable presentation.

## Key findings

- Cutaneous manifestations of GPA can appear years after initial diagnosis.
- Skin lesions in GPA include purpura, pyoderma gangrenosum-like lesions, and livedo.
- GPA should be considered in the differential diagnosis of delayed skin symptoms.

## Abstract

We present the case of a 60-year-old man with granulomatosis with polyangiitis (GPA). While he initially presented with only renal involvement, he developed cutaneous manifestations more than a decade later. Cutaneous manifestations may manifest at any point during the duration of the disease, although most usually present at the onset. Cutaneous manifestations of GPA include petechial-like lesions and palpable purpura, typical of what is seen with small vessel vasculitides, as well as pyoderma gangrenosum (PG)-like lesions, digital necrosis, subcutaneous nodules, and/or livedo, which can also be seen but may be more commonly associated with medium vasculitis. As these manifestations may also be found in tandem with other diseases, it is important to include GPA as part of the differential diagnosis when such skin lesions are identified. Treatment of cutaneous manifestations of GPA includes glucocorticoids and immunosuppressive agents.