Wegener's granulomatosis presenting as pyoderma gangrenosum

Wegener's granulomatosis (WG) is a systemic disease of unknown origin characterized by necrotizing granulomatous inflammation and vasculitis. Dermatological symptoms occur in up to 50% of cases, mostly in the form of cutaneous vasculitis or pyoderma gangrenosum. A 51-year-old female presented with multiple ulcerative patches and erythematous nodules on both legs. Histopathological findings showed extensive ill-defined granulomatous lesions and necrotizing vasculitis. Lung biopsy findings were consistent with WG. Nasopharyngeal and gastrointestinal involvement developed later. Skin lesions are improving with systemic corticosteroid and cyclophosphamide. We herein report a case of WG presenting as pyoderma gangrenosum-like cutaneous manifestation with other systemic involvements.