Small vessel vasculitis with anti-proteinase antibodies 3 is an atypical clinical presentation of tuberculosis. The authors present the case of a 47-year-old male patient, with palpable purpura and palmoplantar hemorrhagic blisters, with subsequent dissemination. He presented severe pulmonary symptoms with cavitation, fever, hemoptysis, and high levels of anti-proteinase 3. Histopathological assessment of the skin revealed small vessel vasculitis; pulmonary histopathology showed granulomas with caseation. Bronchoalveolar lavage was positive for alcohol-acid-fast bacilli. In countries with a high prevalence of tuberculosis, the presence of autoantibodies in a patient with vasculitis, fever, and pulmonary cavitation requires investigation of infectious causes.
A 59-year-old man with a 2-year history of acquired immunodeficiency syndrome, who was adherent to highlyactive antiretroviral therapy, developed tumors in his right inguinal region over one month. He reported loss of appetite, local pain, and fever, soon followed by tumor onset. Physical examination revealed an erythematousto-violaceus plaque extending from the right inguinal region to the inner thigh with underlying multiple friable violaceus tumors and adherent lymph nodes (Fig 1). The CD4 count was 138 cells/mm 3 with undetectable viral load. Skin biopsy, histopathological exam (Fig 2), and immunostainings were performed, including epithelial membrane antigen (EMA), anaplastic lymphoma kinase (ALK) and CD markers (Fig 3). Imaging exams revealed no systemic involvement.
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