We describe a 53 year-old woman with primary biliary cirrhosis presenting with left ankle swelling and a purpuric rash. The skin biopsy of the rash revealed a small vessel vasculitis and a botryomycosis with Splendore-Hoeppli phenomenon. Botryomycosis is an uncommon histologic finding of a chronic suppurative bacterial infection whereby bacteria form aggregates, which are surrounded by an eosinophilic matrix. With guidance from the skin biopsy findings, the patient was appropriately treated with antibiotics, resulting in complete resolution of symptoms.