A 16 year old boy was admitted to the hospital for evaluation of a 10 pound weight loss, cough, fever, and chills for a month. Several days later he developed tender purpuric papules and vesicles on the elbows, knees and ankles. Skin biopsy showed abscesss in the deep dermis and subcutaneous fat filled with neutrophils and clumps of Gram positive cocci. Multiple abscesses were discovered in his liver and lungs. He had an elevated IgE and family members with findings consistent with hyperimmunoglobulin E syndrome. For more details on his evaluation, diagnosis,and treatment see the CME case entitled "A 16 year old boy with weight loss, fever, chills and a purpuric vesicular rash."
abscess with clumps of neutrophils and bacteria extending from the deep dermis into the subcutaneous fat