Bronchopneumonia With Cutaneous Vasculitis: A Diagnostic Challenge

Abstract

Bronchopneumonia associated with atypical cutaneous manifestations poses a significant diagnostic challenge because of the broad spectrum of infectious, inflammatory, autoimmune, and vasculitic disorders that may present with overlapping clinical features. Careful clinicopathological correlation is often required to establish the diagnosis and identify the underlying etiology. A 73-year-old man presented with fever, productive cough, progressive dyspnea, and bilateral pulmonary infiltrates. During hospitalization, he developed painful erythematous plaques over the left leg accompanied by hemorrhagic lesions over both palms and the left sole. The initial clinical differential diagnosis included erythema nodosum and urticarial vasculitis. An extensive evaluation, including bronchoscopy with microbiological investigations, autoimmune serology, and blood cultures, did not identify a definitive underlying cause. Skin biopsy demonstrated features suggestive of cutaneous vasculitis, establishing the diagnosis following clinicopathological correlation. The patient showed progressive improvement with systemic corticosteroid therapy, with parallel resolution of both the cutaneous lesions and pulmonary abnormalities. This case highlights the importance of a systematic multidisciplinary approach in patients presenting with concurrent bronchopneumonia and atypical cutaneous manifestations. Integrating clinical, radiological, microbiological, serological, and histopathological findings is essential for distinguishing among infectious, inflammatory, autoimmune, and vasculitic disorders and for guiding appropriate management.