case_images: PMC4664794_01
case_images: Initial lesion: erythematous nodule on right shin.
case_images: CRIRH2015-517025.001.jpg
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case_images: fig1
case_images: Erythematous tender nodules were noticed on bilateral lower extremities (Figure 1).
case_images: Ultrasound upper abdomen. Multiple hypoechoic tiny lesions on both lobes, few of them cystic in appearance.
case_images: CRIRH2015-517025.002.jpg
case_images: PMC4664794_01_CRIRH2015-517025.002.jpg
case_images: fig2
case_images: An upper abdominal ultrasound showed hypoechoic, cystic lesions scattered across both lobes of the liver (Figure 2).
case_images: CT abdomen with contrast: multiple hypoattenuating lesions in the liver.
case_images: CRIRH2015-517025.003.jpg
case_images: PMC4664794_01_CRIRH2015-517025.003.jpg
case_images: fig3
case_images: A subsequent CT scan of the abdomen with contrast showed multiple oval hypoattenuating lesions in both lobes of the liver (Figure 3).
case_images: Liver biopsy. Cholestasis with multiple large areas of necrosis palisaded by epitheloid cells with associated granulomatous inflammation.
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case_images: PMC4664794_01_CRIRH2015-517025.004.jpg
case_images: fig4
case_images: Ulceration in the nodule with erythema and discharge.
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case_images: PMC4664794_01_CRIRH2015-517025.005.jpg
case_images: fig5
case_images: Leg lesions were becoming worse with central necrosis and purulent discharge (Figures 5 and 6).
case_images: Ulceration progressing to central necrosis.
case_images: CRIRH2015-517025.006.jpg
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case_images: fig6
case_images: Leg lesions were becoming worse with central necrosis and purulent discharge (Figures 5 and 6).
case_images: Skin biopsy. Vasculitis involving the superficial and deep dermis showing fibrinoid necrosis of vessel wall with granuloma formation, neutrophilic infiltrate, and nuclear debris.
case_images: CRIRH2015-517025.007.jpg
case_images: PMC4664794_01_CRIRH2015-517025.007.jpg
case_images: fig7
case_images: Pathological examination of frozen sections revealed surface ulceration with fibrinoid necrosis and vasculitis involving superficial and deep dermal vessels along with granuloma formation, neutrophilic infiltration, and debris (Figure 7).
case_images: After treatment with 7 weeks of prednisone and azathioprine.
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case_images: PMC4664794_01_CRIRH2015-517025.008.jpg
case_images: fig8
case_images: After seven weeks on prednisone and six weeks of azathioprine her lesions had healed almost completely (Figure 8).