PMC4672604_01
Bilateral, erythematous poorly-delineated plaques of different shapes and sizes, surrounding small areas of normal skin are seen in both feet and ankles. Lesions are more confluent over the toes and interdigital folds. Interphalangeal and metatarsophalangeal joints are diffusely swollen.
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Positive physical findings included a dry oral mucosa and a generalized erythematous macular rash which was more intense and confluent on feet (Fig. 1), axillary folds and forearms.
Diffuse facial edema and erythema with marked bilateral palpebral swelling.
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His clinical status deteriorated over 48 h with the onset of generalized soft tissue edema, distinctive palpebral and facial swelling (Fig. 2), multiple bullae, hemodynamic instability, hepatic cholestasis, atrial fibrillation with rapid ventricular response, metabolic acidosis, and oliguric acute kidney failure.
PMC4672604_02
Diffuse facial edema with multiple confluent ecchymoses on the eyelids, cheeks and upper neck. A sharply delineated necrotic lesion covers the patient's entire nasal region.
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A conspicuous, sharply delineated and necrotic skin lesion over the entire nasal region appeared (Fig. 3).
PMC4672604_03
Generalized confluent ecchymoses are seen over the trunk of the patient. Extended uniform erythematous violaceous plaques involve the upper limbs and are more intense on distal areas. A diffuse inflammatory swelling of the right hand and the interphalangeal and metacarpophalangeal joints is visible.
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His hands were swollen, hot, and extremely painful, exhibiting an intense violaceous erythematous rash (Fig. 4).
Ecchymotic plaques cover most of the face of the patient, being more conspicuous and confluent on his cheeks, philtral area and nostrils.
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Distinct, rapidly confluent cyanotic areas covered the philtral area, nostrils and later the entire nasal region (Fig. 5).
PMC4672604_04
Diffuse inflammatory swelling of the right hand. Confluent ecchymoses of palm and fingers, as well as necrosis of finger tips, are evident.
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Large generalized purpuric lesions were evident on her limbs, face and oropharynx, as well as acrocyanosis in both hands and feet with localized necrosis of finger tips (Fig. 6).
Characteristic bullae filled with abundant serous fluid, along with confluent ecchymotic plaques on patient's arm.
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Rapidly expanding bullae developed on both upper and lower limbs (Fig. 7).