PMC3038343_01
A. Scattered necrotic bullae and blisters on the dorsum of the feet are visible, with necrotic tips of the toes. Aggressive progression of necrosis had occurred within 10 days of the onset of blisters, and within 2 days of the patient noticing ischemia on the tips of her toes. B. Necrotic fingertips, palmar aspect.
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F1
There was diffuse superficial, livedo-like purpura on her thighs, frank necrosis of the tips of all her toes and 4 fingers, but no ulcerative lesions (Figures 1A, 1B).
Skin biopsy of the right shin: fibrinoid necrosis can be seen around the blood vessel wall (thin white arrow); an infiltrate of neutrophils, neutrophilic debris, and scattered eosinophils can also be seen (thick white arrow).
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F2
Skin (punch) biopsy of the right shin showed small-vessel vasculitis with fibrinoid necrosis in the vessel wall, leukocytoclasia, and eosinophilia (Figure 2).