case_images: PMC6330183_01
case_images: (a) Clinical photograph of the lower limbs showing numerous erythematous palpable purpura predominantly spread over the extensor surface. (b) Magnified view of the cutaneous lesion showing raised erythematous purpura with a dark necrotic center.
case_images: OMJ-D-17-00039-f1.jpg
case_images: PMC6330183_01_OMJ-D-17-00039-f1.jpg
case_images: f1
case_images: On examination, the patient was pale and had palpable purpura over both thighs and buttocks [Figure 1].
case_images: Presence of (a) intracellular and (b) extracellular Leishman-Donovan bodies. Giemsa staining, magnification = 1000 x.
case_images: OMJ-D-17-00039-f2.jpg
case_images: PMC6330183_01_OMJ-D-17-00039-f2.jpg
case_images: f2
case_images: Peripheral blood antibodies towards rK39 antigen were positive, and bone marrow examination confirmed visceral leishmaniasis with the presence of typical Leishman-Donovan bodies (amastigote form) within the bone marrow histiocytes [Figure 2].
case_images: (a) Hematoxylin and eosin staining of skin biopsy samples revealing leukocytoclastic vasculitis with extensive fibrinoid necrosis within dermal capillaries, magnification = 200 x. (b) Fibrinoid necrosis destroying the vessel wall with extravasation of red blood cells and nuclear debris in the adjacent areas, magnification = 400 x.
case_images: OMJ-D-17-00039-f3.jpg
case_images: PMC6330183_01_OMJ-D-17-00039-f3.jpg
case_images: f3
case_images: Skin biopsy of the rashes revealed fibrinoid necrosis of the vessel wall along with extravasation of red blood cells and nuclear debris in the adjoining areas consistent with a diagnosis of leukocytoclastic vasculitis [Figure 3].