Digital gangrene a rare early manifestation of Wegener’s granulomatosis: a case report

Wegener's granulomatosis (WG) or Granulomatosis with polyangiitis (GPA) rarely presents with digital gangrene being an early manifestation. We report a case of 60-year-old woman who presented with fever and cough with occasional hemoptysis along with painful bilateral feet digital gangrene. X ray chest and HRCT thorax of the patient was suggestive of multiple nodulo-cavitatory lesions. HPE of the lung lesion showed granulomatous pathology. CT Angiography was suggestive of multiple calcified and non-calcified lesions in infra renal aorta with stenosis of right dorsalis pedis artery. Biopsy of the skin lesion revealed a leucocytoclastic vasculitis. We eventually diagnosed GPA in light of clinical symptomatology with HPE of lung mass showing granulomatous lesion along with a positive cANCA. A few months after starting combined cyclophosphamide and steroids patient had significant symptomatic improvement. Hence Wegener’s granulomatosis should always be considered as a possibility while evaluating a patient of digital gangrene specially with pulmonary and renal involvement.