PMC10052476_01
Multiple purpuric patches and plaques with an annular morphology located on soles (a, b), palms (c), and lips (d).
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Clinical examination revealed multiple annular purpuric patches and plaques distributed on the palms, soles, lips and hard palate (Figure 1), while systemic examination revealed no abnormalities.
Histology showing a dense infiltrate in the dermis (with a perivascular and interstitial distribution) and surrounding the adipose lobules: (a) dermal and subcutaneous blood vessels show thickened walls infiltrated by eosinophils and endothelial hypertrophy with consequent vascular lumen obliteration (b, c).
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In the superficial and deep dermis, there was a dense infiltrate composed of numerous eosinophils admixed with lymphocytes and histiocytes (Figure 2). Dermal and subcutaneous blood vessels exhibited thickened walls infiltrated by eosinophils and endothelial hypertrophy with consequent vascular lumen obliteration, though in the absence of fibrinoid necrosis of the vessel walls (Figure 2). There were extravasated red blood cells in the papillary dermis and focally in the epidermis, and few intravascular neutrophils in the dermis (Figure 2).