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Dec 2012

Acrally Distributed Purpuric and Necrotic Lesions With Pustular Features—Diagnosis

Arch Dermatol. 2012;148(12):1412. doi:10.1001/archderm.148.12.1412-b

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.

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