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Eosinophilic granulomatosis with polyangiitis followed by venous thromboembolism resulting in severe cutaneous ulcers

Dear Editor, Eosinophilic granulomatosis with polyangiitis (EGPA) is a disorder associated with asthma and eosinophilia characterized by eosinophil-rich and granulomatous inflammation, as well as necrotizing vasculitis of small to medium vessels. Half of EGPA patients have cutaneous manifestations, but skin ulcers are rarely observed. A 48-year old man presented a deep ulcer covered with necrotic tissue on his right thigh (Fig. 1a), which expanded quickly with a fever for a month, accompanied by livedo reticularis (Fig. 1b). Past history included asthma and allergic rhinitis. Laboratory examinations revealed eosinophilia (blood eosinophil count: 3396/lL), hyperimmunoglobulinemia including an elevated immunoglobulin E serum level (739 U/mL), an increased level of serum C-reactive protein (11.47 mg/dL) and plasma D-dimer (23.1 lg/mL). Antineutrophil cytoplasmic antibody was negative. Histopathological examination revealed non-granulomatous leukocytoclastic necrotizing vasculitis of the small arteries and the capillaries accompanied by infiltrates consisting of eosinophils, neutrophils, and lymphocytes with