A 47-year- old man with a history of dermatomyositis presented with a 4-day history of abdominal pain, fever, melena, and hemoptysis and a 2-week history of rash. A punch biopsy of the rash revealed the findings (image attached). What is the most likely diagnosis?

*This patient case is from Docplexus Editorial Team for educative purpose only. Source: NEJM The answers are posted in the comments section Click here .