Therapy With Doxycycline and Hydroxychloroquine Enables Surgical Excision of Ulcerated Cutaneous Granulomas in a Patient With Ataxia Telangiectasia

The rubella virus vaccine strain can cause granulomas in patients with inborn errors of immunity that may evolve into chronic, recalcitrant ulcers. This report details treatment of ulcerated rubella granulomas in a patient with ataxia telangiectasia with doxycycline and hydroxychloroquine resulting in partial ulcer healing within 4 weeks, which in turn enabled surgical excision. Though this treatment did not cure or clear the rubella virus, that is known to persist in patients with inborn errors of immunity like ataxia telangiectasia, it enabled durable local lesion control of typically chronic, highly morbid ulcers. Histopathology of skin and bone lesions, the latter not previously described in the literature, is included.