title: [Primary cutaneous manifestation of Wegener's granulomatosis].
abstract: METHODS
  A 57-year-old man was admitted with hemorrhagic papules and necrotising nodules on both elbows and upper legs. Recurrent arthralgia occurred.
  
  
  METHODS
  The skin biopsy showed a cutaneous necrotising vasculitis. Positive test results for c-ANCA and proteinase 3 antibodies and a slightly increased WBC and a mild proteinuria were noticeable.
  
  
  METHODS
  The diagnosis of an early systemic Wegener's granulomatosis was based on elevated proteinase 3-titres and cutaneous histologic findings as necrotising vasculitis and granulomatous inflammation. Treatment with prednisolone followed by methotrexate resolved the cutaneous symptoms and the arthralgia completely. Three months later the patient developed a progredient methotrexate toxicity caused by a glomerulonephritis.
  
  
  CONCLUSIONS
  Wegener's granulomatosis should be considered if a cutaneous necrotising vasculitis is diagnosed. A cutaneous manifestation could be an early symptom. Methotrexate could be used for treatment of mild courses of Wegener's disease without renal involvement.
authors.affiliation: Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Kromayer-Str. 5, 06097 Halle, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Bramsiepe
authors.forename: B
authors.initials: B
authors.lastname: Danz
authors.forename: R
authors.initials: R
authors.lastname: Heine
authors.forename: K-M
authors.initials: KM
authors.lastname: Taube
authors.forename: H-J
authors.initials: HJ
authors.lastname: Holzhausen
authors.forename: W C
authors.initials: WC
authors.lastname: Marsch
authors.forename: E
authors.initials: E
authors.lastname: Fiedler
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001706:Biopsy; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000139:chemically induced; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use / Q000633:toxicity; D007868:Leg Dermatoses / Q000175:diagnosis* / Q000276:immunology; D007958:Leukocyte Count; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use / Q000633:toxicity; D008875:Middle Aged; D053146:Myeloblastin / Q000276:immunology; D009336:Necrosis; D011239:Prednisolone / Q000627:therapeutic use / Q000633:toxicity; D012867:Skin / Q000473:pathology; D017445:Skin Diseases, Vascular / Q000175:diagnosis* / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D011239:Prednisolone; D053146:Myeloblastin; D008727:Methotrexate