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Dec 2012

Acrally Distributed Purpuric and Necrotic Lesions With Pustular Features—Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

Arch Dermatol. 2012;148(12):1411. doi:10.1001/archderm.148.12.1411-b

A 50-year-old woman presented with new-onset painful blisters on her palms and distal extremities. She had associated fevers (102°F), myalgias, arthralgias, headache, and photophobia. Physical examination revealed multiple pustules and red papules distributed over the palmar surface of both hands, the bilateral extensor arms, and to a lesser extent on the bilateral lower extremities (Figure 1). Most lesions had a violaceous halo. The patient denied any recent hiking or camping. A 4-mm punch biopsy specimen was obtained from the left arm (Figure 2 and Figure 3).

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