case_images: PMC3728493_01
case_images: Palpable, purpuric rash and confluent ecchymoses on both legs and in the soles.
case_images: CRIM.RHEUMATOLOGY2013-678427.001.jpg
case_images: PMC3728493_01_CRIM.RHEUMATOLOGY2013-678427.001.jpg
case_images: fig1
case_images: One week before admission, he noticed nonulcerating, painful purpuric rash on both legs (Figure 1). A palpable, purpuric rash and confluent ecchymoses were noted on both legs, most pronounced at the medial aspects of thighs and lower legs (Figure 1). Walking and even mild physical exercise resulted in severe worsening of pain and progression of purpura into ecchymoses (Figure 1). During the following days, suggilations appeared in the soles (Figure 1).
case_images: A punch biopsy from the right lower leg shows a sparse, perifollicular, lymphocytic infiltrate and extravasation of erythrocytes. There is hyperkeratosis of the slightly dilated follicular infundibulum. The two transverse sections of the intracorneal parts of a hair shaft (arrows) show the spiraling course of the hairs (cork screw appearance) characteristic of scurvy.
case_images: CRIM.RHEUMATOLOGY2013-678427.002.jpg
case_images: PMC3728493_01_CRIM.RHEUMATOLOGY2013-678427.002.jpg
case_images: fig2
case_images: A skin biopsy showed erythrocyte extravasation and follicular hyperkeratosis, but no vasculitis, complement or immunoglobulin deposits (Figure 2).