Recalcitrant Necrotic Cutaneous Ulceration: An Unusual Presentation of
Granulomatosis with Polyangiitis associated with Alpha-Antitrypson
Deficiency
Abstract
A 39-year-old female with multiple necrotic cutaneous ulcerations as a
presenting finding of Granulomatosis with Polyangiitis(GPA)is
reported.Failing to respond to initial immunosuppressant therapy
revealed a complicating codiagnosis of alpha-antitrypson
deficiency(AAD).We outline the importance of this clinical association
and advise that AAD should be considered in all cases of GPA
, 
