In addition to the obvious cutaneous lesions, the mucous membranes of the respiratory and digestive tracts are affected, although the lesions are less obvious. Lesions are most common on the pharynx, tongue, and upper part of the trachea and esophagus, consisting of hemorrhages and pseudomembranes. Endothelial cells lining the sinusoids of the liver are often swollen and sometimes necrotic. Reticuloendothelial hyperplasia is seen in bone marrow and spleen. The kidneys may be hemorrhagic and liver heavier than normal. Encephalitis occurs rarely.

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