Pheochromocytoma misdiagnosed as allergic vasculitis in a 36-year-old male led to ulcer healing but required toe amputation.

This case report details the clinical course of a 36-year-old male patient. The patient presented with bilateral lower extremity ulcers and was initially diagnosed with allergic vasculitis. Subsequent investigation revealed the underlying cause was pheochromocytoma, a condition often lacking classic symptoms. The patient underwent surgery for the pheochromocytoma, which was the primary intervention. Immunosuppression was the prior management strategy for the suspected vasculitis.

Following the surgical removal of the pheochromocytoma, the patient's bilateral lower extremity ulcers demonstrated healing. However, the clinical course was complicated by the development of toe necrosis. This adverse event ultimately required toe amputation. The patient was followed for a period of 24 years post-intervention.

The safety profile included the occurrence of toe necrosis leading to amputation, while the ulcers themselves resolved. No other adverse events or discontinuations were reported. The study is limited by its design as a single case report, which precludes generalization of findings to broader populations. Funding sources and conflicts of interest were not reported. This case highlights diagnostic pitfalls associated with atypical pheochromocytoma presentations that mimic allergic vasculitis. It emphasizes the importance of dynamic biomarker monitoring for early detection in such scenarios.