Granulomatous cutaneous rheumatoid vasculitis

Rheumatoid vasculitis is a term that includes many vascular reactions from capillaritis to severe systemic necrotizing vasculitis occurring in a patient with rheumatoid arthritis (RA), but generally has been used to describe an immune complex reaction. The presence of vasculitis in the patient with RA has often been associated with a poorer prognosis; however, the prognosis is dependent on the presence of systemic disease. We report a patient with RA in whom multiple purpuric, cutaneous nodules, diffuse interstitial fibrosis, and high levels of circulating immune complexes developed. The cutaneous disease was characterized by a granuloma formation secondary to leukocytoclastic vasculitis.