Abstract
Rheumatoid vasculitis (RV) is a rare extraarticular manifestation of severe seropositive rheumatoid arthritis (RA), affecting small and medium vessels and associated with significant morbidity and mortality. The incidence of RV has significantly decreased in the last three decades due to early diagnosis and better management of RA with biologics. Still, the mortality rate remains high and there are insufficient controlled studies guiding RV treatment. Here, we discussed a case of a 75-year-old male who presented with a non-healing ulcer on lateral malleolus without significant joint pain, the workup showed very high titer rheumatoid factor with erosive joint disease raising high clinical suspicion of RV. Skin biopsy was negative for histologic evidence of vasculitis. He had complete healing of the ulcer with prednisone and methotrexate (MTX). This case highlights the importance of promptly recognizing this rare entity and that a negative biopsy does not rule out RV, and appropriate treatment helps decrease morbidity and mortality.