PMC5109578_01
Macroscopic and microscopic findings of the skin lesion. (A) Palpable purpura progressed rapidly into extensive ecchymoses on the back (left), trunk (right upper), and right foot and ankle (right lower). (B) A fascia biopsy of the right crus showing fresh fibrin thrombi (arrows), including neutrophils within a small dilated vessel [Hematoxylin and Eosin (H&E) staining; original magnification 20x]. (C) A skin biopsy showing infiltration of neutrophils with karyorrhectic nuclear debris, and extravasation of erythrocytes around small vessels in the dermis, leading to a diagnosis of leukocytoclastic vasculitis (H&E staining; original magnification 20x). (D) A skin biopsy showing immunoglobulin M and C3 deposition within the walls of a small vessel in the dermis (immunofluorescence stain; original magnification 20x).
1349-7235-55-3047-g001.jpg
PMC5109578_01_1349-7235-55-3047-g001.jpg
g001
Palpable red-violet plaques were observed on the right lower limb, as were extensive ecchymoses on the trunk (Fig. 1A), and there was a dramatic progression from petechiae to confluent ecchymoses on the skin. The pathologic findings from the fascia biopsy revealed fresh fibrin thrombi including neutrophils in a small dilated vessel (Fig. 1B). A skin biopsy from fresh purpura performed on the ninth day after hospital admission revealed infiltration of the neutrophils along with karyorrhectic nuclear debris and extravasation of erythrocytes around the small vessels in the dermis (Fig. 1C). An immunofluorescence examination revealed both immunoglobulin M (IgM) and C3 deposited within the wall of small vessels, but no immunoglobulin A (IgA) (Fig. 1D).
Macroscopic and microscopic findings of the colon lesion. (A) Colonoscopy showing widespread inflammation with multiple skip ulcers. (B) A colon biopsy showing colonic mucosa with slightly irregular-shaped, distributed crypts and granulation tissue (Hematoxylin and Eosin staining; original magnification 20x).
1349-7235-55-3047-g002.jpg
PMC5109578_01_1349-7235-55-3047-g002.jpg
g002
Total colonoscopy on the 17th day after hospital admission revealed widespread inflammation involving the entire colon, with multiple skip ulcers (Fig. 2A). A colon biopsy revealed non-specific colitis with ulceration (Fig. 2B).