case_images: PMC11250282_01
case_images: Clinical features of this patient at the first visit. Erythematous lesions are evident on the trunk (a) and the upper thighs (b), some of which have central crusting and ulcers.
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case_images: PMC11250282_01_cde-2024-0016-0001-538767_F01.jpg
case_images: F1
case_images: Some of these lesions evolved into purpuric papules and, within a month of their onset, were accompanied by pustules and crusted ulcers (Fig. 1a, b).
case_images: a, b Histopathological findings reveal acanthosis, parakeratosis, scattered necrotic keratinocytes, and spongiosis. There is also a perivascular and lichenoid infiltration that is predominantly lymphocytic, accompanied by vacuolar alteration of the basal layer. (a, b Hematoxylin-eosin stain; original magnifications: a, x100; b, x200.) Immunohistochemical staining for CD4 (c, original magnifications: x100) and CD8 (d, original magnifications: x100) indicates that primarily CD8+ cells have infiltrated the epidermis. A few granzyme B-positive inflammatory cells are present in both the epidermis and the papillary dermis. e Immunohistochemical staining for Granzyme B; original magnifications: x400.
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case_images: F2
case_images: Additionally, perivascular and band-like lymphocytic infiltration, predominantly with vacuolar alteration of the basal layer, was evident (Fig. 2a, b). Immunohistochemistry showed infiltration of both CD4+ and CD8+ T cells in the epidermis and papillary dermis, with a predominance of CD8+ cells (Fig. 2c, d). Granzyme B-positive inflammatory cells were also slightly present (Fig. 2e).
case_images: a, b Clinical features of this patient 3 weeks after administration of oral prednisolone. Erythematous lesions are improved.
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case_images: PMC11250282_01_cde-2024-0016-0001-538767_F03.jpg
case_images: F3
case_images: Approximately 2 weeks after starting oral prednisolone (10 mg/day), the skin rash and itching gradually improved (Fig. 3a, b).