The skin biopsy showed epidermal necrosis with superficial and deep dermal mixed inflammation (Figure 2). In the dermis was vascular disruption, including vessels with fibrin thrombi (Figure 3). Scattered, medium-sized CD30+ lymphocytes were noted (not shown). The patient had just returned from South Africa, where he had spent time on safari. Serologic samples drawn 20 days after initial symptoms revealed spotted fever group (IgM, 1:64; IgG, >1:512), Rickettsia africae (IgG 1:4096), and Rickettsia conorii (IgG, 1:16384) (reference range for all serologic results is ≥ 1:64 = positive). After 3 weeks, his symptoms resolved, and therefore no further treatment was needed. At the 6-week follow-up, he was recovering well with no sequelae.
Purpura, Eschars, and Leg Edema in a Traveler —Diagnosis. Arch Dermatol. 2012;148(2):247–252. doi:10.1001/archderm.148.2.247-f
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