A 53 year old man presented with a 4 day history of a rapidly progressive, painful purpuric eruption on the lower extremities. The symptoms started as red to purple papules, some in a linear array, on the anterior and medial lower extremities several hours after working outside his house clearing foliage. The posterior legs were completely spared. Over the ensuing days, the lesions continued to progress, coalescing into large confluent purpuric plaques with surrounding purpuric papules and admixed multi-loculated hemorrhagic bullae (Figure 1). There were no lesions elsewhere on his body. He denied fever, chills, malaise, arthralgia, abdominal pain, hematuria, or other systemic symptoms. He had no significant medical history and took no medications.
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