PMC3339713_01
Skin findings on the first examination and histopathological findings. a, b There were many erythematous lesions of 6-10 mm in diameter with crusted ulcer, pustule, blister, and blood blister. Palpable purpura of 2-5 mm in diameter was diffusely present. c Pustules and thick yellow scales were present on the soles. d Blisters were present under the epidermis. Dense infiltration of inflammatory cells containing numerous neutrophils and lymphocytes was noted in the upper dermis and the walls of small blood vessels in the upper to lower dermal layers (HE staining, x40). e Skin biopsy specimen showed leukocytoclastic vasculitis characterized by infiltration of neutrophils, nuclear dust, fibrinoid deposits, and erythrocyte extravasation in and around small blood vessels (HE staining, x400).
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F1
At the first examination, many erythematous lesions with purpura, blood crusts, and blisters were present in the lower legs and dorsum of the feet (fig. 1a, b). Pustules and thick yellow scales were present on the soles (fig. 1c), and erythemas were present on the palms.
a Chest CT showed a large volume of bilateral pleural effusion. b Pantomography showed a radicular cyst ( ) in the right lower canine and apical periodontitis ( ) in the right lower first molar, with alveolar bone resorption ( ) noted in the right lower central incisor, canine, second molar, and left lower lateral incisor to the first premolar.
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F2
Chest CT indicated a large volume of bilateral pleural effusion (fig. 2a). Moreover, alveolar bone was resorbed in one half to one third of the root length in the right lower central incisor, canine, second molar, and left lower lateral incisor to the first premolar, leading to a diagnosis of moderate to severe chronic periodontitis (fig. 2b).