PMC9437347_01
(A) Rash in neck. (B) Congestion and edema of right auricle. (C) Necrosis of right auricle. (D) Right auricle excision and flap transplantation. (E) Histopathology of right ear (Hematoxylin -Eosin stainingx40), black arrow: cartilage, yellow arrow: necrosis and red arrow: necrosis and red arrow: hemorrhage. (F,G) The histopathologic examination of skin of right ear revealed microthrombi in small vessel (red arrows) (Hematoxylin-Eosin staining).
fped-10-950576-g0001.jpg
PMC9437347_01_fped-10-950576-g0001.jpg
F1
Moreover, she had a rash (Figures 1A,B) in face and neck accompanied by swelling and pain of the right auricle (Figure 1B), which became necrotic (Figure 1C). The right auricle had to be removed, and new skin had to be grafted on from her neck (Figure 1D). Pathological changes from the auricle and its surrounding skin displayed microvascular thrombogenesis (Figures 1E-G).
Kidney biopsy of findings showed negative IgA, IgM, Clq, and faint IgG under immunofluorescence (x400) microscopy, normal glomerular change (HE&PASM: periodic acid-silver metheramine) under light microscopy (x400), diffuse podocyte foot process effacement (FPE) in absence of sub-epithelial or sub-endothelial deposition under electron microscopy (x11,600).
fped-10-950576-g0002.jpg
PMC9437347_01_fped-10-950576-g0002.jpg
F2
Kidney biopsy was performed because of persistent haematuria and proteinuria, and the findings displayed negative immunofluorescence (IF) for immunoglobulin A (IgA), IgM, fibrinogen (Fb), C3, and C1q, except faint IgG (Figure 2); a normal glomerular appearance under light microscopy (Figure 2); and diffuse podocyte foot process effacement in the absence of subepithelial or subendothelial deposition on EM (Figure 2).