Purpuric Eruption in a Patient Treated With Systemic Steroids—Quiz Case

A 58-year-old woman presented with Escherichia coli bacteremia, vancomycin-resistant Enterococcus faecium meningitis, and septic shock. Before this presentation, she had received systemic corticosteroids on 3 separate occasions at another hospital for exacerbations of chronic obstructive pulmonary disease as a result of 1-antitrypsin disease. Physical examination revealed an extensive purpuric rash on her abdomen (Figure1) and the anterior aspect of her thighs.Shediedshortlyafterward.Sectionsof skinobtained atautopsyshowedparasiticorganismsinthesuperficialdermis (Figure 2 and Figure 3) and subcutaneous fat. What is your diagnosis?