case_images: PMC9354131_01
case_images: Case #1: Top panels demonstrating palpable purpura with tense overlying
  bullae throughout bilateral upper and lower extremities. Bottom panel with
  H&E staining from a punch biopsy at 10 times magnification demonstrating
  neutrophilic spongiosis, superficial dermis with perivascular and
  interstitial infiltrate of neutrophils, dust of neutrophils and extravasated
  erythrocytes.
case_images: 10.1177_20499361221113464-fig1.jpg
case_images: PMC9354131_01_10.1177_20499361221113464-fig1.jpg
case_images: fig1-20499361221113464
case_images: He was initially treated with intravenous vancomycin; however, on hospital day #2 he developed painful palpable purpura with tense overlying bullae on the bilateral upper and lower extremities (Figure 1) with associated joint pain. Punch biopsy of the skin lesions was performed on hospital day #5 with H&E staining yielding findings consistent with leukocytoclastic vasculitis, with histopathology demonstrating perivascular and interstitial infiltrates of polymorphonuclear cells with neutrophil dust (Figure 1).
case_images: PMC9354131_02
case_images: Case 2: Top panels demonstrating purpuric ulcerations over bilateral lower
  extremities. Bottom panel with H&E staining from a punch biopsy at 20
  times magnification demonstrating superficial dermal blood vessels plugged
  with fibrin thrombi.
case_images: 10.1177_20499361221113464-fig2.jpg
case_images: PMC9354131_02_10.1177_20499361221113464-fig2.jpg
case_images: fig2-20499361221113464
case_images: On presentation she had painful and pruritic purpuric ulcerations along the bilateral lower extremities (Figure 2). Punch biopsy of a skin lesion was obtained on hospital day #8 (the patient declined to undergo biopsy earlier in the hospitalization) and demonstrated vasculitis with features of coagulopathy, with histopathology showing fibrin thrombi in dermal blood vessels (Figure 2).