PMC7412890_01
Shows patients lower extremity images before and after eculizumab therapy. Images A to H show the patient's right and left lower extremity prior to eculizumab therapy. Images I to L show the patients right and left lower extremity 48 hours after eculizumab therapy.
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The left foot was cool and dusky with edema and the first left great toe was amputated-pulses present (Figure 1A and B). The amputation site was dry and black and the tip of the third toe was black (Figure 1A). Large open wounds were present on bilateral shins (Figure 1C and D). The left lateral leg ulcer measured 8 x 3 cm with an unknown true depth (Figure 1C). The right medial leg had an ulcer measuring 6.5 x 5.5 cm at the skin level with a dry and black wound base with no drainage or odor (Figure 1E-H). The patient had significant improvement in several of his lower extremity ulcerations (Figure 1I-L) and had a sustained creatinine within normal limits.
Hematoxylin-eosin (H&E) sections from skin over the left foot shows extensive dermal hemorrhage (A and B) and rare fibrin thrombi in small vessels. H&E sections of skin and subcutaneous tissue from the right leg (C and D) show numerous fibrin thrombi within small vessels.
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Skin biopsy from his left lower extremity wound showed tissue hemorrhage (Figure 2A and B) and fibrin thrombi (Figure 2C and D) with immunofluorescence showing antibodies against immunoglobulin (Ig) G, IgM, IgA, C3, and fibrin, suggestive of immune-mediated vascular injury.