Case Number : Case 2944 - 19 October 2021 Posted By: Uma Sundram

There are some vasculitis changes in the subcutis with fibrinoid necrosis and RBCs extravasation. Is a young woman with alcohol abuse, may be we should ask about cocaine use. Cocaine related retiform purpura.

The epidermal changes of patchy parakeratosis, slight upper epidermal pallor and vacuolation suggest a nutritional deficiency which might be expected with the clinical history of alcoholism.

The appearances in the fat are difficult to interpret as the slide is overexposed. There appears to be congestion in the lobular capillaries with some red cell extravasation.  This makes me wonder about co-existent scurvy.

The last two pictures show fat necrosis. I wonder whether it's pancreatic panniculitis due to pancreatitis developing in a chronic alcoholic patient 

Last two images are not clear but seems like thrombotic vasculopathy. The dermal and epidermal changes might be secondary to occlusive vasculopathy.

The epidermal changes suggest an acrodermatitis enteropatia secondary to alcoholism, as Richard said. The subcutaneous fibrinoid(?) vasculopathy could be a porphiria-like occurrence. 

Great suggestions. She had a developing vasculopathy which caused extensive necrosis. We considered calciphylaxis as she had some scattered vascular calcification, but her kidney function was normal. Apologies for delay in posting; there was something wrong with my ability to access the website. I think it's fixed now.