Necrotizing vasculitis is caused by extensive transmural inflammation and ultimately necrosis of fibrinoid tissue, which can lead to deep necrotic and ischemic ulcerations. Small to medium sized vessels are typically affected and may have multiple skin manifestations along with systemic symptoms. Palpable purpura is typically seen in necrotizing vasculitis. Other findings including nodules, liver racemosa, and urticaria. There are multiple possible etiologies including vasculitides, drug reactions, infections, or other underlying conditions. Treatment includes high dose glucocorticoids.