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April 1997

Palpable Purpura and Respiratory Failure

Author Affiliations

Department of Dermatology, St Louis University Health Sciences Center, St Louis, Mo

Arch Dermatol. 1997;133(4):435-437. doi:10.1001/archderm.1997.03890400031004

REPORT OF A CASE  A 54-year-old man with a 20-year history of sinus problems developed a fever, dry cough, arthralgias, and profound malaise. The symptoms were progressive and he was hospitalized 3 weeks after they developed. An asymptomatic skin rash, predominantly involving the lower extremities, was first observed 7 days prior to admission.His medical history was notable for several surgical procedures for recurrent sinus problems, a nasal septal prosthesis that was removed 1 month prior to hospital admission, and a thyroidectomy. Medications the patient was taking on admission included levothyroxine sodium and cefuroxime sodium, which he started taking approximately 4 weeks prior to admission for a dental procedure.Findings of the initial physical examination revealed a temperature of 38.7°C, saddle nose deformity, bulging tympanic membranes, clear lungs, and normal heart sounds. Swelling, tenderness, and warmth were noted in both knees and the left ankle. There was no lymphadenopathy or