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Following adequate skin biopsy to establish a diagnosis, we initiated targeted therapy with rituximab, azathioprine, and high dose steroids with reversal of the ischemic process. The patient had been refractory to therapy with findings of early digital necrosis. The case presented involves CPAN in which the main arteries to the feet are occluded. Journal of the American Medical Association (JAMA) maintain EndNote database. Due to CPAN's predilection for the lower extremities, involvement of the limb at or below the ankle's major arteries may result in loss of digits and potentially feet. Faculty Coordinator at UT Southwestern Medical Center. As a single organ vasculitis, CPAN can affect arteries of any size. CPAN is characterized as a benign, chronic, relapsing vasculitis to be treated conservatively. The presence of IgM antiphosphatidylserine-prothrombin complexes has led to the hypothesis that CPAN is a localized arthrus reaction. Diagnosis is established by skin biopsy demonstrating segmental leukocytoclastic vasculitis and fibrinoid necrosis with workup excluding any systemic involvement ( Figure 1). Cutaneous Polyarteritis Nodosa (CPAN) is a rare, single organ vasculitis of unknown etiology which presents with livedo reticularis and tender nodules involving the lower extremity in 97% of cases.