Nongranulomatous septic vasculitis due to miliary tuberculosis. A pitfall in diagnosis for the pathologist

A 38-year-old patient with chronic alcoholism was on chemotherapy for acute myelomonocytic leukemia and developed purpuric and erythematous papules. Skin biopsy showed a vasculitis. Subsequent autopsy revealed disseminated tuberculosis with a poor cellular response. This case calls attention to the lack of tuberculoid granulomatous reaction is anergic patients and to the need of pathologists to suspect tuberculosis when necrotizing vasculitis in the skin is encountered in a patient with decreased immunological competence.