PMC3481924_01
Photograph shows healing subcutaneous ulcer over thigh (a) and leg (b)
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F1
The general physical examination showed normal vitals with multiple subcutaneous ulcers predominantly distributed over both the lower limbs [Figures 1a and b] and bluish black discoloration of distal phalanx of the index finger.
[H and E, x400] shows normal epidermis and the dermis with inflammatory infiltrate, eosinophils and neutrophils (a) superficial dermis with destruction of the vessel walls by inflammatory infiltrate (b) (arrow)
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F2
The deep incisional skin biopsy taken from the subcutaneous nodule revealed leukocytoclastic vasculitis of the dermal vessels [Figures 2a and b]. The patient was treated with methyl prednisolone (three pulses doses of 750 mg/day) followed by oral prednisolone of 1 mg/kg/day.
Photograph shows healed subcutaneous ulcer over thigh with scarring (a) and healed gangrene of finger (b) (i.e., autoamputated distal phalanx)
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F3
The skin lesions completely healed over a period of six months with scarring [Figures 3a and b], and patient was on regular follow up for one and half year after which she lost to follow up and treatment.