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Continued.
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Physical exam revealed several variously sized purpura, necrosis, erosion and ulcers located on her right arm and hand (Figure 1A and B).  CT angiography of the right upper limb showed a high origin of the radial artery, meanwhile both high originating radial artery and the anastomoses were tortuous and were of relatively small caliber (Figure 1E and F). Without any other specific treatment except tissue debridement during two weeks, her ulcers diminished and most of the purpuras fell off, leaving focal atrophic scars (Figure 1C and D).
Continued.
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A skin biopsy taken from the ulcer border revealed extensive loss of the epidermis, fibrosis of dermis (Figure 2A), mild infiltration by lymphocytes and neutrophils (Figure 2C), and necrosis of the focal eccrine ducts (Figure 2B).
Clinical Findings and CT angiography of the right upper limb. Erosion, ulcers (A), variously sized purpura and necrosis (B) on admission. The ulcers diminished and most of the purpuras fell off (C and D) after two weeks. High originating radial artery as well as the tortuous and slender anastomoses (E and F).
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There was no erythema, bullae or ulcers on any part of her skin during a 2-year follow-up after discharge (Figure 3A and B).