A brief review and case report of pheochromocytoma misdiagnosed as allergic vasculitis with bilateral lower extremity ulcers: a 24-year clinical course.

We report a 36-year-old male with pheochromocytoma presenting solely as progressive bilateral lower limb necrosis for 24 years, lacking classic symptoms (hypertension, headache, palpitations). Misdiagnosed as allergic vasculitis, he developed atrophic scars and toe necrosis despite immunosuppression. Elevated catecholamines and a 4.8 cm adrenal mass confirmed the diagnosis. Postoperatively, ulcers healed, but toe amputation was needed. This case highlights diagnostic pitfalls of atypical pheochromocytoma, emphasizing dynamic biomarker monitoring for early detection.