Skin Biopsy: quite characteristic, showing bacterial invasion of the media and adventitia of veins deep in the dermis (intima and lumen of the vein are spared)
Progresses to bullous, pustular, or hemorrhagic lesions
Gangrenous ulcers with surrounding erythema: may occur within 12-24 hrs
Usually less than 10 lesions are present, most often found in the gluteal or perineal regions, but also appearing on the extremities, trunk, and face in descending order, respectively
Treatment
Aminoglycoside + Antipseudomonal Penicillin:
Ceftazidime
Imipenem
Surgical Debridement: often required
Prognosis
Related to Absolute Neutrophil Count: the lower the absolute neutrophil count (ANC), the poorer the prognosis
Patients with an ANC < 500 cells/mm3 (0.5 x 109/L) rarely survive
