A 71-year-old man presented with 4 weeks of a diffuse rash along with 1 week of bilateral elbow and knee pain. For the past year, he had recurrent episodes of diverticulitis complicated by colovesical fistula. Six weeks ago, he underwent sigmoid colon resection with fistula repair. He had no fever, abdominal pain, dysuria, or urinary frequency. He was prescribed prednisone when the rash first presented (starting at 30 mg/d and decreased by 10 mg every 4 days). The rash improved initially but recurred at the 10-mg/d prednisone dosing. Medical history included glaucoma, gastroesophageal reflux disease, and osteoarthritis. His home medications included lansoprazole, probiotics, vitamin B12, folic acid, vitamin D3, prednisone (10 mg/d), and timolol eye gel. He had no sick contacts or recent travel and reported no alcohol or tobacco use.
Chalhoub NE, Kaw D, Nagaraja V. A Man With a Nonblanchable Purpuric Rash. JAMA. 2017;317(22):2329–2330. doi:10.1001/jama.2017.4954
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