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
Dias BM, Nahass GT. Palpable Purpura and Respiratory Failure. Arch Dermatol. 1997;133(4):435–437. doi:10.1001/archderm.1997.03890400031004
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