PMC9528754_01
Cervical angiotomography showing bilateral, symmetrical and concentric internal and external carotid arteries stenosis over 70% (yellow arrows).
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The cerebral angiotomography revealed a bilateral, symmetrical and concentric internal carotid stenosis over 70% ( Figure 1 ); the brain MRI showed multiple white matter lesions consistent with acute infractions and the largest lesion was in the right centrum semiovale owing to the patient's neurological deficit.
Violaceous discoloration and necrosis on the distal feet region.
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On day 8 after admission, peripheral bluish coloration was observed in the fingers and toes with a decrease in pulse amplitude in the four limbs ( Figure 2 ).
A) Leukocytoclastic vasculitis with karyorrhexis and fibrinoid necrosis;(B) Diffuse dermal immune infiltrate predominantly composed of plasma cells and histocytes; Cutaneous vasculitis: perivascular infiltrate of polymorphonuclear neutrophils, monocytes and lymphocytes, as well as endarteritis obliterans (Hematoxylin-eosin)
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Large and medium size vessels presented endarteritis obliterans with dense plasma cell infiltration ( Figure 3 ); taken together, these histological findings suggested syphilitic vascular and skin affection; unfortunately, the Warthin-Starry stain and immunohistochemistry using anti-T. pallidum specific antibodies were not available.