Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis affecting small- to medium-sized vessels via antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase 3.1 Cutaneous involvement, including palpable purpura, nodules, ulcers, and necrotizing lesions, occurs in 50% of cases.2 We report 2 cases of seronegative GPA sharing distinctive clinical and histopathological features.