Recalcitrant Necrotic Cutaneous Ulceration: An Unusual Presentation of Granulomatosis with Polyangiitis associated with Alpha-Antitrypson Deficiency

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