PMC5576416_01
Photography of patient's cellulitis: swelling and redness of his left lower leg.
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The area of erythema and swelling rapidly increased in size within a short period (Figure 1).
Histopathological findings. (a) Skin biopsy specimen shows neutrophil infiltrations around vessels in the upper dermis, also known as leukocytoclastic vasculitis (hematoxylin and eosin stain; original magnification x100). (b) Duodenal biopsy specimen shows eosinophil infiltration of the mucous membrane (hematoxylin and eosin stain; original magnification x400).
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A skin biopsy specimen from a purpuric lesion revealed leukocytoclastic vasculitis in the upper dermis (Figure 2(a)) and a duodenal biopsy specimen from the duodenal ulcer also showed eosinophil infiltration into the mucous membrane (Figure 2(b)).
Changes of palpable purpura and duodenal ulcer before and after prednisolone administration. (a) Appearance of palpable purpura during the treatment of streptococcal cellulitis. (b) Improvement of palpable purpura after prednisolone administration for 2 weeks. (c) Severe duodenal ulcer with anaphylactoid purpura shown via endoscopy. (d) Improvement of duodenal ulcer after prednisolone administration for 2 weeks shown via endoscopy.
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Day 48 showed a dramatic improvement of the duodenal ulcer (Figure 3). Despite negative blood culture results, the anti-streptolysin O (ASO) and anti-streptokinase (ASK) antibody titers were elevated at 336 IU/mL (normal range < 239 IU/mL) and 2560 (normal range < 2560) on Day 35, respectively.