{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T14:07:12Z","timestamp":1758636432542},"reference-count":11,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2007,2,6]],"date-time":"2007-02-06T00:00:00Z","timestamp":1170720000000},"content-version":"vor","delay-in-days":67,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Skinmed"],"published-print":{"date-parts":[[2006,12]]},"abstract":"A 15\u2010year\u2010old Caucasian girl presented with a 1\u2010week history of necrotic ulcers on her bilateral lower extremities, associated with fever and malaise. She had had similar ulcerations on and off over the past 3 years. She had a medical history of Graves' disease, diagnosed in 1999, for which she was taking methimazole (MMI). On physical examination, there were multiple necrotic ulcers with elevated, inflamed borders and an overlying eschar on the bilateral distal extremities (Figure\u20031<\/jats:ext-link>). There was one hemorrhagic, flaccid bulla on the lateral aspect of the ankle. Her complete blood count, comprehensive metabolic panel, prothrombin time, and international normalized ratio were within normal limits. Histopathology revealed a neutrophilic vasculitis involving small as well as medium\u2010sized blood vessels. The overlying epidermis and upper dermis showed necrosis (Figure\u20032<\/jats:ext-link>). Antinuclear antibody (ANA) was positive at 1:160. Perinuclear (p\u2010) antineutrophil cytoplasmic antibody (ANCA) was positive at 1:320. Cytoplasmic ANCA was negative. The patient did not meet any clinical criteria for a diagnosis of lupus erythematosus. Direct immunofluorescence revealed IgM, complement C3, and fibrin in small\u2010 and medium\u2010caliber blood vessels in the dermis, consistent with a leukocytoclastic vasculitis of small\u2010 and medium\u2010caliber blood vessels (Figure\u20033<\/jats:ext-link>). MMI was stopped and the patient was given prednisone, tapered over 5 days. Her thyroid function remained stable, and she did not develop new necrotic ulcers. One month later, the patient developed urticarial lesions on her lower extremities. Histopathology revealed a lymphocytic vascular reaction. No eosinophils or neutrophils were seen. These newer urticarial lesions resolved. The patient underwent debridement of the thick, necrotic ulcerative eschars. To date, her lesions have resolved (Figure\u20034<\/jats:ext-link>). An ANA drawn S months after withdrawal of MMI was negative, and p\u2010ANCA was 1:67.<\/jats:p> On initial physical examination, there were multiple necrotic ulcers with elevated, inflamed borders and an overlying eschar on the bilateral distal extremities.<\/jats:italic> <\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p> Neutrophilic vasculitis involving small as well as medium\u2010sized blood vessels. The overlying epidermis and upper dermis showed necrosis and dermolysis. There is necrosis in the vessels. Hematoxylin and eosin stain; original magnification \u00d77 00.<\/jats:italic> <\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p> Direct immuno\u2010fluorescence revealed IgM, complement C3, and fibrin in small\u2010 and medium\u2010caliber blood vessels in the dermis, consistent with a leukocytoclastic vasculitis of small\u2010 and medium\u2010caliber blood vessels. Fluorescein\u2010conjugated goat antihuman IgM stain; original magnification \u00d7200.<\/jats:italic> <\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p> On 5\u2010month follow\u2010up, the ulcers have nearly completely healed.<\/jats:italic> <\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>","DOI":"10.1111\/j.1540-9740.2006.05350.x","type":"journal-article","created":{"date-parts":[[2007,2,6]],"date-time":"2007-02-06T23:52:07Z","timestamp":1170805927000},"page":"302-305","source":"Crossref","is-referenced-by-count":7,"title":["Perinuclear Antineutrophil Cytoplasmic Antibody\u2010Associated Vasculitis in a Patient With Graves' Disease Treated With Methimazole"],"prefix":"10.1111","volume":"5","author":[{"given":"Donna Bilu","family":"Martin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Gaspari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick","family":"Pearson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,2,6]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.84.1.13"},{"key":"e_1_2_2_3_2","unstructured":"National Institutes of Health.The National Women's Health Center 2004."},{"issue":"4","key":"e_1_2_2_4_2","first-page":"S1295","article-title":"Antineutrophil cytoplasmic antibody\u2010positive systemic vasculitis associated with propylthiouracil therapy: report of 2 children with Graves' disease","volume":"85","author":"Poomthavorn P","year":"2002","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.1995.tb01340.x"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/00015550260132523"},{"key":"e_1_2_2_7_2","first-page":"772","article-title":"Methimazole\u2010induced pulmonary hemorrhage associated with antimyeloperoxidase\u2010antineutrophil cytoplasmic antibody: a case report","volume":"100","author":"Tsai MH","year":"2001","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.7973636"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.11.4270"},{"key":"e_1_2_2_10_2","first-page":"274","article-title":"Prevalence of perinuclear antineutrophil cytoplasmic antibody in patients with Graves' disease treated with propylthiouracil or methimazole in Taiwan","volume":"103","author":"Huang CN","year":"2004","journal-title":"J Formos Med Assoc"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021383"},{"key":"e_1_2_2_12_2","first-page":"296","article-title":"PTU\u2010associated cutaneous vasculitis with ANCA anti\u2010MPO and anti\u2010PR3 antibodies","volume":"61","author":"Jacobs EM","year":"2003","journal-title":"Nefh J Med"}],"container-title":["SKINmed: Dermatology for the Clinician"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1540-9740.2006.05350.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1540-9740.2006.05350.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T11:41:07Z","timestamp":1697024467000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1540-9740.2006.05350.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,12]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2006,12]]}},"alternative-id":["10.1111\/j.1540-9740.2006.05350.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1540-9740.2006.05350.x","archive":["Portico"],"relation":{},"ISSN":["1540-9740","1751-7125"],"issn-type":[{"value":"1540-9740","type":"print"},{"value":"1751-7125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,12]]}}}