Cutaneous lesions from 12 patients with chronic gonococcal sepsis were studied by light microscopy. The essential histopathologic findings were related to the dermal vessels. Hemorrhage and vasculitis were invariably present; thrombosis was found in 11 of the 12 biopsies. Epidermal changes ranged from mild edema to vesiculopustule formation to necrosis. Gram-negative diplococci could not be demonstrated in any biopsy. The dermatopathologic changes in gonococcemia paralleled those found in meningococcemia. The vasculitic changes in chronic gonococcal sepsis, the difficulty in demonstrating organisms in cutaneous lesions, and the ease with which antigenic material of Neisseria gonorrhoeae can be found with the direct immunofluorescent technique suggest that the Shwartzman phenomenon may be responsible for producing tissue damage.
Shapiro L, Teisch JA, Brownstein MH. Dermatohistopathology of Chronic Gonococcal Sepsis. Arch Dermatol. 1973;107(3):403-406. doi:10.1001/archderm.1973.01620180057017