Advancing into the Community Darlene LeFrancois, MD, Sharon Leung, MD  The American Journal of Medicine  Volume 125, Issue 7, Pages 657-660 (July 2012) DOI: 10.1016/j.amjmed.2012.04.001 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 On day 2 of hospitalization, a coronal view of abdominal computed tomography demonstrated marked pancolitis (white arrows). The American Journal of Medicine 2012 125, 657-660DOI: (10.1016/j.amjmed.2012.04.001) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 The patient was seriously ill. A, Purpura fulminans was evident on her right leg. B, The left leg also was affected. C, She had necrosis of the nose and lips. D-F, Her left middle finger, right toes, and left foot were gangrenous. The American Journal of Medicine 2012 125, 657-660DOI: (10.1016/j.amjmed.2012.04.001) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Dermatopathology included thrombotic vasculopathy with tissue ischemia and necrosis. A, Subepidermal clefting indicates vascular congestion (hematoxylin and eosin [H&E], 4x). B, Subepidermal clefting indicative of vascular congestion is shown under higher magnification (H&E, 10x). C, Purpura (black arrow) appears as red blood cells that have been extravasated from small vessels in dermis (H&E, 40x). D-E, Fibrin thrombi are seen in small superficial dermal vessels (H&E and phosphotungstic acid-hematoxylin—PTAH—staining, respectively), 40x. F, Tissue ischemia and necrotic eccrine units are present in the sample (H&E, 40x). The American Journal of Medicine 2012 125, 657-660DOI: (10.1016/j.amjmed.2012.04.001) Copyright © 2012 Elsevier Inc. Terms and Conditions