PMC9340174_01
Skin lesions. (A) A black necrotic eschar, about 3x7 cm, in the center of the redness and swelling at the left thigh root. (B) The lower limbs are scattered with erythema and necrotic crusts.
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The texture was hard and difficult to peel, and there were subcutaneous nodules on the periphery (Figures 1A and B). The lower limbs were scattered with purpuric and necrotic crusted lesions (Figure 1B).
Changes in the laboratory examination results. (A) Regular blood test. (B) Coagulation function. (C) Liver function. (D) Muscle enzymology and renal function. (E) Blood glucose and electrolytes.
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A variety of sensitive and broad-spectrum antibiotics were utilized and administered based on experience or drug sensitivity results. (3) Medium-dose glucocorticoids (ie, methylprednisolone), intravenous immunoglobulin, hemostasis, acid suppression and stomach protection, liver protection, etc., were given (Figure 6: Main medications and treatments). After treatment, the patient's condition improved, and all abnormal laboratory indicators mentioned above gradually returned to their normal ranges (Figure 2: Changes in laboratory examination results).
(A) Klebsiellasubsp. from secretions under the scab of the lesion on a MacConkey agar plate (top) and on a blood plate (bottom). (B) Positive oral mucosa fungus microscopic examination.
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Three specimens were positive for Klebsiella pneumoniae (Figure 3A). The results of the high-throughput genetic testing of the pathogenic microorganism DNA were consistent. Additionally, an oral mucosa fungus microscopic examination was positive (Figure 3B).  
Left thigh root skin biopsy. (A) Focal hypokeratosis, formation of serous callus, atrophy, and thinning of the epidermis (hematoxylin staining [HE] x 40). (B) Extensive liquefaction and degeneration of the cells in the basal layer (HE x 200). (C) Fibrinoid necrosis of the vessel wall at the reticular layer of the dermis (HE x 100). (D) Extensive collagen fiber necrosis and mixed inflammatory cell infiltration dominated by lymphocytes and neutrophils can be seen around the blood vessel and between the collagen fibers, and eosinophils are rare (HE x 100). (E) Subcutaneous adipose tissue septal hyperplasia, where thrombosis is seen in the vascular cavity and some fat cells are degenerated and necrotic (HE x 200).
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Right calf skin biopsy. (A) Epidermis is slightly thickened, and blood vessels in the middle and upper dermis are hyperplastic (hematoxylin staining [HE] x 40). (B) There is no obvious fibrinoid necrosis in the vessel wall, and no thrombosis is formed in the vascular cavity. The blood vessels are dominated by focal infiltration of the mononuclear cells, and scattered eosinophils can also be seen (HE x 200).
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Main medications and treatments.
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A variety of sensitive and broad-spectrum antibiotics were utilized and administered based on experience or drug sensitivity results. (3) Medium-dose glucocorticoids (ie, methylprednisolone), intravenous immunoglobulin, hemostasis, acid suppression and stomach protection, liver protection, etc., were given (Figure 6: Main medications and treatments). After treatment, the patient's condition improved, and all abnormal laboratory indicators mentioned above gradually returned to their normal ranges (Figure 2: Changes in laboratory examination results).