PMC7201786_01
(a) Erythematous confluent macular and papular follicular eruption on his left upper arm. (b) The eruption involving the acral surfaces. (c) Marked facial swelling. (d) Oral mucosa ulcers.
CRIID2020-2150314.001.jpg
PMC7201786_01_CRIID2020-2150314.001.jpg
fig1
The following day his rash had progressed, becoming more confluent and spreading to involve his distal upper and lower limbs with profound perifollicular accentuation (Figure 1(a)). His palms also revealed faint macular erythema (Figure 1(b)). He also developed marked facial swelling (Figure 1(c)) as well as petechial changes over his hard palate with associated ulceration of his oral mucosa (Figure 1(d)).
(a) Lymphohistiocytic infiltrate surrounding superficial dermal vessels and histiocytes aggregating into poorly formed granulomas (x100 magnification). (b) Warthin-Starry special stain showing numerous spirochaetes amongst the lymphohistiocytic infiltrate (x400 magnification).
CRIID2020-2150314.002.jpg
PMC7201786_01_CRIID2020-2150314.002.jpg
fig2
There were aggregates of histiocytes leading to the formation of poorly formed granulomas (Figure 2(a)). A Warthin-Starry stain was performed showing moderate numbers of spiral and curved bacilli within histiocytes, features in keeping with spirochaetes (Figure 2(b)).