Differential Diagnosis

The patient's presentation of a visibly asymmetric condition, unresponsive to stents, with fluctuating inflammation and a confirmed history of leukocytoclastic vasculitis (LCV), suggests a complex autoimmune or inflammatory process. The following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Chronic leukocytoclastic vasculitis (LCV): Given the patient's confirmed history of LCV, this condition is likely the primary cause of the symptoms. LCV is characterized by inflammation of small blood vessels, which can lead to skin lesions and other systemic symptoms.
• Other Likely Diagnoses
  • Relapsing polychondritis: This condition involves recurring episodes of cartilage inflammation and could explain the asymmetric appearance and fluctuating inflammation.
  • Granulomatosis with polyangiitis (GPA): Formerly known as Wegener's granulomatosis, GPA is a form of vasculitis that affects small- and medium-sized vessels and can cause a wide range of symptoms, including skin lesions and inflammation.
  • Ehlers-Danlos syndrome: A group of disorders that affect connective tissues, which could contribute to the asymmetric appearance and potentially explain the lack of response to stents.
• Do Not Miss Diagnoses
  • Giant cell arteritis: Although less likely given the patient's age and presentation, giant cell arteritis is a serious condition that can cause vision loss and other complications if left untreated.
  • Systemic lupus erythematosus (SLE): Despite the patient's negative primary autoimmune tests, SLE can be challenging to diagnose, and a salivary gland biopsy may help rule out this condition.
  • Sjögren's syndrome: Another autoimmune disorder that can cause inflammation and damage to exocrine glands, particularly the salivary and lacrimal glands.
• Rare Diagnoses
  • Malignant otitis externa: A rare but serious infection of the outer ear and skull base, which can cause significant inflammation and damage.
  • Relapsing linear acantholytic dermatosis: A rare skin condition characterized by recurring episodes of blistering and skin lesions.
  • Necrobiotic xanthogranuloma: A rare condition that causes skin lesions and can be associated with systemic diseases, such as lymphoma or plasma cell dyscrasias.