A 60-year-old man with destructive rheumatoid disease, multiple nodules, and vasculitis developed a facial rash with ulceration and scarring. Histology showed granulomatous vasculitis. The rash was rapidly controlled with oral corticosteroids. Granulomatous vasculitis has not previously been reported as causing this clinical picture in the absence of concomitant necrobiosis and palisading.
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