Beyond Ulcerations: A Case of Cutaneous Polyarteritis Nodosa in a Middle-Aged Woman

Polyarteritis nodosa (PAN) is an immune-mediated necrotizing vasculitis predominantly affecting medium-sized arteries, often manifesting with systemic involvement in its classic form. However, a cutaneous variant (cutaneous polyarteritis nodosa (c-PAN)) confines the disease process to the skin and subcutaneous tissues, typically presenting with painful nodules, chronic ulcerations, and livedo reticularis while sparing major organ systems. Here, we describe a 53-year-old woman with type 2 diabetes and hypertension who developed persistent, painful ulcerative nodules on her lower legs over six months. Laboratory investigations revealed elevated inflammatory markers, negative ANCA, and slightly increased C3. Histopathology confirmed necrotizing arteritis of medium-sized arteries with lobular panniculitis, consistent with c-PAN. She was treated successfully with oral corticosteroids, azathioprine, and supportive wound care, achieving clinical remission without progression to systemic disease. This case underscores the importance of recognizing c-PAN in recalcitrant lower-extremity ulcers and highlights the value of a multidisciplinary approach for optimal patient outcomes.