case_images: PMC9552674_01
case_images: Skin disorder in forms of multiple bullous and ulcers on both of the legs (A and E), hands (B and C), and feet (D). On the back, there were erythematous macules and scale lesions (F).
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case_images: Dermatological assessment revealed erythematous macules, vesicles, bullae, erosions, pustular crusts, and scales on both hands, back, buttocks, legs, and feet (Figure 1A-F).
case_images: (A) Chest radiographic examination showed necrotizing granulomatous appearance (red arrow). (B) Histopathological examination revealed vesiculobullous reaction on subcorneal area (red arrow). Inflammatory cell and extravasation of erythrocytes in papillary dermis (black arrow). (C) Nasopharyngoscopy examination showed crusts (red arrow) that bleeds easily on nasal cavity.
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case_images: Chest radiography showed a thick-walled lucent shadow filled with infiltrates on the upper- to middle-left lung field, which is supporting the appearance of necrotizing granulomatous (Figure 2A). There was also inflammatory cell and extravasation of the erythrocyte on papillary dermis (Figure 2B). Nasopharyngoscopy revealed crusts in both nasal cavities that bleed easily (Figure 2C).
case_images: After 6-month of treatment, multiple bullous and ulcers in both legs (A and E), hands (B and C), and feet (D) disappeared. Some of the macule and scale lesions at back also disappeared (F).
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case_images: The patient was in complete remission state after six months of treatment (Figure 3A-F), followed by a relapse episode that manifested as new skin ulcers and hematuria one year later.