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.