Introduction: Pustular vasculitis is a rare skin disease with only a few reported cases worldwide, especially when the lesions occur on the lower limbs. This report presents a rare case of pustular vasculitis on both lower limbs, and good therapeutic effects were achieved after our treatment. Case Presentation: We report a case of an 86-year-old female who presented with annular erythema, purpura, and pustules on both lower limbs. Skin biopsies showed neutrophilic infiltration and leukocytoclastic vasculitis changes. She had a history of chronic diarrhea for the past two years. X-ray of both hands revealed osteoarthritis of multiple interphalangeal joints. After treatment with systemic methylprednisolone, minocycline and tripterygium glycosides for anti-inflammation, the lesions were significantly relieved. Conclusion: We report this case because of its rarity and remind physicians to keep in mind of the possibility of pustular vasculitis while dealing with lesions of extensive annular haemorrhagic spots with pustules, along with diarrhea and arthritis.