Microscopic examination revealed a dense dermal perivascular infiltrate with a predominance of neutrophils and extravasated red blood cells. Higher-power magnification demonstrated nuclear dust (karyorrhexis) and the presence of neutrophils and fibrin within vessel walls.
Leukocytoclastic vasculitis is a common cause of purpuric lesions on the extremities. Bacterial endocarditis should be considered, especially if the patient has a fever and an underlying heart murmur, because acute management of this life-threatening condition is required.
Palpable Purpura on the Extremities. Arch Dermatol. 2001;137(7):957-962. doi: