At presentation, skin lesions caused extreme discomfort due to pain and bleeding

At presentation, skin lesions caused extreme discomfort due to pain and bleeding

At presentation, skin lesions caused extreme discomfort due to pain and bleeding

Clinical image at presentation. There were generalized ulceronecrotic plaques which spared mucous membranes

Clinical image at presentation. There were generalized ulceronecrotic plaques which spared mucous membranes

Punch biopsy of an incipient cutaneous lesion. There is focal interface dermatitis with basal hydropic degeneration, scant dyskeratosis, and a superficial perivascular lymphocytic infiltrate (HE, ×400)

Punch biopsy of an incipient cutaneous lesion. There is focal interface dermatitis with basal hydropic degeneration, scant dyskeratosis, and a superficial perivascular lymphocytic infiltrate (HE, ×400)

Clinical image 2 weeks following hospital discharge. Most lesions showed clear signs of healing, albeit with scarring and hyperpigmentation

Clinical image 2 weeks following hospital discharge. Most lesions showed clear signs of healing, albeit with scarring and hyperpigmentation

Two weeks following hospital discharge, there was striking improvement of the skin lesions, with complete resolution of pain and no fever recurrence

Two weeks following hospital discharge, there was striking improvement of the skin lesions, with complete resolution of pain and no fever recurrence

a Severe, extensive, crusted papules and papulovesicles, hemorrhagic bullae, weeping erosions, and collarettes of scale on the patient's back. b Violaceous papules, purpuric, umbilicated, hemorrhagic bullae, and numerous scalloped confluent ulcerations on the patient's right leg.

a Severe, extensive, crusted papules and papulovesicles, hemorrhagic bullae, weeping erosions, and collarettes of scale on the patient’s back. b Violaceous papules, purpuric, umbilicated, hemorrhagic bullae, and numerous scalloped confluent ulcerations on the patient’s right leg.

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