UPDATE: I originally posted this as an unknown, but have become convinced that Dr. Stewart’s diagnosis of levamisole vasculopathy is correct. This decedent had similar lesions on his nose and cheeks, which is consistent with this diagnosis, and has a history of crack/cocaine use. For nice reviews, see here and here.
It all goes to show how important individual experience is. I’ve never seen it (or at least didn’t notice it) in many years of experience. One of my younger colleagues here looked and said it was a no-brainer — she saw it all the time where she trained. Doh.
So, on with the pretty pictures:
This is from a young middle-aged white male who died of a methamphetamine overdose. He suffered delirium and seizures prior to death, and had a number of superficial blunt trauma injuries. Examination of the scalp revealed this injury. While it is erythematous and has a vague appearance of scattered abrasion, the variegation and lack of obvious skin defects made it more likely a rash of some sort.
Here’s the gross picture:
Histologically, the keratinizing epithelium is intact, but there is a vasculitis with perivascular extravasation of erythrocytes: