Cutaneous nodules occurring ten years before diagnosis of necrotizing respiratory granulomatosis.

Introduction. - Although cutaneous disorders preceding Wegener's granulomat osis are common, they usually are not isolated clinical features. We descri be the case of a patient who presented Wegener's granulomatosis-related cut aneous disorders ten years before diagnosis, suggesting a protracted form o f the disease. Exegesis. - At first visit in 1987 a 44-year-old woman presented leg skin n odules since six months. Following biopsy clinical findings showed non-spec ific inflammation. Due to lung nodular lesions tuberculosis was diagnosed i n 1993, Though bacteriology did not confirm diagnosis, treatment was succes sful, After relapse in 1996, thoracotomy was performed and anatomic patholo gy findings uncovered Wegener's granulomatosis. The patient's history showe d many flares of skin nodules since 1986. This is only in 1997 that cutaneo us pathologic findings showed the existence of Wegener's granulomatosis. Conclusion. - The time to diagnosis after the occurrence of the first clini cal signs is usually shorter than that observed. Superficial, protracted fo rms of the disease have been described. As in the present case, they raise diagnostic issues regarding the lack of specificity of anatomic pathology f indings. This also suggests that Wegener's granulomatosis and infections mi ght be related. (C) 2000 Editions scientifiques et medicales Elsevier SAS.