PMC6330183_01
(a) Clinical photograph of the lower limbs showing numerous erythematous palpable purpura predominantly spread over the extensor surface. (b) Magnified view of the cutaneous lesion showing raised erythematous purpura with a dark necrotic center.
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On examination, the patient was pale and had palpable purpura over both thighs and buttocks [Figure 1].
Presence of (a) intracellular and (b) extracellular Leishman-Donovan bodies. Giemsa staining, magnification = 1000 x.
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Peripheral blood antibodies towards rK39 antigen were positive, and bone marrow examination confirmed visceral leishmaniasis with the presence of typical Leishman-Donovan bodies (amastigote form) within the bone marrow histiocytes [Figure 2].
(a) Hematoxylin and eosin staining of skin biopsy samples revealing leukocytoclastic vasculitis with extensive fibrinoid necrosis within dermal capillaries, magnification = 200 x. (b) Fibrinoid necrosis destroying the vessel wall with extravasation of red blood cells and nuclear debris in the adjacent areas, magnification = 400 x.
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Skin biopsy of the rashes revealed fibrinoid necrosis of the vessel wall along with extravasation of red blood cells and nuclear debris in the adjoining areas consistent with a diagnosis of leukocytoclastic vasculitis [Figure 3].