The biopsy specimen showed pustular vasculitis with fibrin thrombi. There was overlying papillary dermal edema with an interstitial proliferation of the neutrophils with extension into the epidermis (Figure 2 and Figure 3).
Results from a blood chemistry panel on admission showed a slight leukocytosis. Other laboratories results, including a basic metabolic panel, liver function tests, and urinalysis, were unremarkable. Lumbar puncture was performed and showed no signs of infection. Blood cultures grew Streptobacillus moniliformis.
Acrally Distributed Purpuric and Necrotic Lesions With Pustular Features—Diagnosis. Arch Dermatol. 2012;148(12):1412. doi:10.1001/archderm.148.12.1412-b
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