PMC9129884_01
(A) A 5 cm x 5 cm grayish granuloma lesion in the oral palate; (B) Ecchymosis on bilateral lower extremities; (C) Skin ulcers with infection in the toes.
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F1
There was a 5 cm x 5 cm grayish-white necrotic tissue bulging from the right side of the oral palate (Figure 1A). The lower extremities showed ecchymosis with skin ulceration and necrosis in the left toes (Figures 1B,C).
(A) Necrosis of segmental capillary loops, PAS, 200 x; (B) Detachment of renal tubular epithelial cells and infiltration of interstitial inflammatory cells. PAS, 400 x.
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F2
The final renal pathology diagnoses were acute tubulointerstitial kidney injury and antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis with kidney injury (nodular necrotic lesions) (Figures 2A,B).
(A) Oral granuloma healed after treatment for 6 months; (B) Foot ulcer healed after treatment for 4 months.
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F3
Oral granuloma, foot ulcers, and nose and throat lesions were also healed (Figures 3A,B).