PMC3604871_01
LCV rash on various parts of the body. a, b Rash affecting hands and wrists bilaterally. c-e Rash involving both lower extremities: d shows rash effecting right buttock, c and e show rash effecting bilateral popliteal and calf regions. f Facial involvement.
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F1
The following day after Ceretec-tagged WBC scan patient was noted to have multiple erythematous painful lesions around wrist area and violaceous erythematous papules involving metacarpophalangeal joints which progressively became generalized (as shown in fig. 1).
a Inflammatory cells surrounding blood vessels in dermis (4x). b, c (10x), d (20x) Neutrophils surround and infiltrate blood vessel wall, d also shows loss of endothelial cells. e, f Small blood vessels with fibrin deposition in wall and neutrophils (10x and 40x, respectively); f also shows loss of endothelial cells consistent with vasculitis.
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F2
Skin punch biopsy was performed which demonstrated neutrophils surrounding and infiltrating the wall of the blood vessel, fibrin deposition in the walls of the blood vessels and loss of the endothelial cells which confirmed the diagnosis of the LCV (fig. 2).