case_images: PMC10857780_01
case_images: (a) Presence of scars and necrotic ulcers on the face as well as the involvement of the nasal and buccal mucosa with cheilitis. (b) Involvement of the first, third, and fourth toes of the right foot with edema and color changes, as well as the presence of purulent discharge and necrotic ulcers. (c, d, e, f) Disseminated necrotic ulcers in the face, thorax, anterior abdomen, and palms with involvement of the perianal region as well as the rectal mucosa and umbilicated papules around the necrotic ulcers. (g) Erythematous plaque with color changes and edema.
case_images: cureus-0016-00000052043-i01.jpg
case_images: PMC10857780_01_cureus-0016-00000052043-i01.jpg
case_images: FIG1
case_images: Subsequently, skin lesions appeared, characterized by itchy umbilicated vesicles less than 5mm in diameter, beginning on the face but spreading to the entire body, including the palms and soles, with progression to pustules, scabs, and necrotic ulcers, reaching more than 350 in number by the time of his admission (Figure 1).
case_images: Abdominopelvic CT scan showing inflammatory-looking thickening of the region of the rectum and anal canal (a, b).
case_images: cureus-0016-00000052043-i02.jpg
case_images: PMC10857780_01_cureus-0016-00000052043-i02.jpg
case_images: FIG2
case_images: An abdominopelvic CT scan was conducted, which showed evidence of severe proctitis (Figure 2).
case_images: Punch biopsy of umbilicated lesions in the palms with acanthosic epidermis (arrow). (a) Diffuse necrosis of keratinocytes, with full-thickness epithelial involvement, presence of ballooning degeneration in central areas, and intraepidermal bulla formation. (b) Presence of mixed peri adnexal and mild perivascular infiltrate (arrows).
case_images: cureus-0016-00000052043-i03.jpg
case_images: PMC10857780_01_cureus-0016-00000052043-i03.jpg
case_images: FIG3
case_images: New asynchronous lesions continued developing, so skin biopsies were taken (Figure 3).