A 12-year-old girl presented with digital ulcer, palpable purpura and subcutaneous nodules involving the extremities (Fig.1). Systemic examination was normal. Investigations showed a raised erythrocyte sedimentation rate and C-reactive protein. Liver function tests, renal function tests, and complement levels were normal. Rheumatoid factor, anti-nuclear antibody, anti-double stranded DNA, anti-neutrophil cytoplasmic antibody, anti-phospholipid antibody, lupus anti-coagulant and serum cryoglobulins were all negative. ASO titers were normal. Mantoux test and serologies for hepatitis B and C infections were negative. Deep incisional skin biopsy from the foot lesion showed leucocytoclastic small vessel vasculitis of the deep dermis. A diagnosis of Cutaneous Polyarteritis Nodosa (CPAN) was made. The patient responded to high dose pulse methyl prednisolone therapy and is at present on low dose steroid for last 6 months without any relapse (Fig. 2).

Fig. 1 The vesico-bullous skin lesions with a digital ulcer.	Fig. 2 The healing lesions.