PMC8710381_01
PMC8710381_02
Clinical presentation of the patient at the relapse of disease. A soft tissue mass lesion was observed in the oral cavity (arrow).
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In January 2020, at 65 years old, the patient noted a swelling in his left cheek and a non-tender mass in his oral cavity (Fig. 1, arrow).
T2-weighted fluid-attenuated inversion recovery magnetic resonance images obtained before (A) and after (B) rituximab therapy. Right maxillary sinusitis (arrowhead) and a subcutaneous nodule (arrow) were identified (A). After rituximab therapy, the sinusitis had improved, and the subcutaneous nodule had shrunk (B).
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T2-weighted fluid-attenuated inversion recovery magnetic resonance imaging (MRI) (Fig. 2A). Therefore, RTX therapy was repeated, and the patient's maxillary sinusitis and subcutaneous nodule improved (Fig. 2B).
Results of a skin biopsy revealing necrotizing vasculitis. A: Diffuse infiltration of inflammatory cells around the blood vessels (Hematoxylin and Eosin staining; original magnification x400). B: The elastic laminae are partially obscured (Elastica van Gieson stain; original magnification x400).
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A percutaneous biopsy of the subcutaneous nodule was performed via the anterior cheek, and a histopathological assessment revealed diffuse infiltration of inflammatory cells around the blood vessels (Fig. 3A). Although fibrinoid necrosis was not apparent, the elastic laminae were partially obscured (Fig. 3B).