title: Hemorrhagic acneiform lesions in a teenager as the initial presentation of granulomatosis with polyangiitis.
abstract: A 19-year-old girl presented with hemorrhagic acneiform lesions on the face for several months that was unresponsive to conventional acne treatment. A biopsy revealed a noninfectious suppurative granulomatous dermatitis with hemorrhage, possibly representing a ruptured folliculitis. A second biopsy revealed chronic granulomatous dermal inflammation and hemorrhage with foreign body giant cells non-infectious by stains. No vasculitis was noted in either biopsy. Later in her course she developed a severe sinusitis and eventually presented with severe fevers, rapid weight loss, sinusitis, and cough. Further workup produced the diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis). She rapidly improved with intravenous steroids and rituximab. To date, acneiform lesions have only been reported in young adult patients and may represent a clinical manifestation of granulomatosis with polyangiitis unique to this age group, as illustrated in our patient.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Dosal
authors.forename: Erica
authors.initials: E
authors.lastname: Good
authors.forename: Jasem
authors.initials: J
authors.lastname: Alshaiji
authors.forename: Santiago
authors.initials: S
authors.lastname: De Solo
authors.forename: Carlos
authors.initials: C
authors.lastname: Ricotti
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Alvarez-Connelly
mesh_terms: D000152:Acne Vulgaris / Q000150:complications* / Q000473:pathology / Q000628:therapy; D000367:Age Factors; D017668:Age of Onset; D005148:Facial Dermatoses / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D014657:Vasculitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D055815:Young Adult