PMC6667486_01
Palpable purpuric and bullous lesions localized predominantly on the dorsal aspect of hands (A) and feet (B).
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12 days after initiation of oxacillin, skin examination revealed bilateral nontender purpuric papules localized predominantly on the dorsal aspect of the patient's hands and feet (Fig. 1).
Multiple palpable round-ovular lesions cover the lateral (A) and anterior (B) aspect of the lower limbs.
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Skin findings evolved into bullous lesions over the following 24-48 hours and similar lesions were noted on the anterior knee and lateral aspect of thighs (Fig. 2).
Histopathological section demonstrating patchy perivascular neutrophil predominant infiltrate with areas of fibrinoid necrosis of blood vessels, nuclear debris and hemorrhage (H and E, 10x and 40x, respectively) in the dermis.
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Punch biopsies from the bullous skin lesions showed perivascular neutrophil infiltration with fibrinoid necrosis of small vessels consistent with leukocytoclastic vasculitis (Fig. 3).