There is a known association between AATD and cytoplasmic staining anti‐neutrophil cytoplasmic antibodies (c‐ANCA) vasculitis, specifically granulomatosis with polyangiitis, with increased risk in those with PI Z and S (Mahr et al., 2010); however, there have been no reports or mechanistic literature to support AATD manifesting in MMD, and patient's skin biopsy results were felt to be inconsistent with those typically seen in AATD. The gene discussed is PRTN3; the disease is alpha 1-antitrypsin deficiency.