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CASE REPORT
Year : 2022  |  Volume : 25  |  Issue : 9  |  Page : 1611-1614

Etiologic dilemma and challenges of management of nodular vasculitis in tertiary health-care facility: A case report


1 Department of Paediatrics, College of Medicine University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
2 Department of Morbid Anatomy, College of Medicine University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
3 Department of Medical Microbiology, College of Medicine University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria

Correspondence Address:
Dr. C L Odimegwu
Department of Paediatrics, College of Medicine University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_348_22

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Nodular vasculitis is a rare inflammatory disease of the skin and subcutaneous fat tissue, characterized by crops of small, tender, erythematous nodules on the legs, mostly on the calves and shins. We present a 17-year-old adolescent female who presented with a six-month history of cough; recurrent fever and bilateral lower limb multiple ulcerated nodules of 1-month duration. Clinical examination revealed generalized lymphadenopathy with bilateral pitting leg edema which had multiple nodules and discoid ulcers extending from the groin to the ankles and discharging purulent fluid. Tests for human immunodeficiency virus and tuberculosis were negative. Histology of nodule biopsy revealed extensive caseous and coagulative fat necrosis, granulomatous inflammation with epitheloid macrophages and multinucleated giant cells surrounding the necrosis, and lymphoid infiltration of vessel walls with fibrous thickening of the intima, typical of Whitfield-type erythema induratum. There was initial but very transient response to antibiotic treatment, with further deterioration and eventual death from overwhelming sepsis.


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