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February 2010

Purpuric Eruption in a Patient Treated With Systemic Steroids—Quiz Case

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Dermatol. 2010;146(2):191-196. doi:10.1001/archdermatol.2009.364-a

A 58-year-old woman presented with Escherichia coli bacteremia, vancomycin-resistant Enterococcus faecium meningitis, and septic shock. Before this presentation, she had received systemic corticosteroids on 3 separate occasions at another hospital for exacerbations of chronic obstructive pulmonary disease as a result of α1-antitrypsin disease. Physical examination revealed an extensive purpuric rash on her abdomen (Figure 1) and the anterior aspect of her thighs. She died shortly afterward. Sections of skin obtained at autopsy showed parasitic organisms in the superficial dermis (Figure 2 and Figure 3) and subcutaneous fat.