Introduction: Although cutaneous disorders preceding Wegener's granulomatosis are common, they usually are not isolated clinical features. We describe the case of a patient who presented Wegener's granulomatosis-related cutaneous disorders ten years before diagnosis, suggesting a protracted form of the disease.
Exegesis: At first visit in 1987 a 44-year-old woman presented leg skin nodules since six months. Following biopsy clinical findings showed non-specific inflammation. Due to lung nodular lesions tuberculosis was diagnosed in 1993. Though bacteriology did not confirm diagnosis, treatment was successful. After relapse in 1996, thoracotomy was performed and anatomic pathology findings uncovered Wegener's granulomatosis. The patient's history showed many flares of skin nodules since 1986. This is only in 1997 that cutaneous pathologic findings showed the existence of Wegener's granulomatosis.
Conclusion: The time to diagnosis after the occurrence of the first clinical signs is usually shorter than that observed. Superficial, protracted forms of the disease have been described. As in the present case, they raise diagnostic issues regarding the lack of specificity of anatomic pathology findings. This also suggests that Wegener's granulomatosis and infections might be related.