Abstract
A 46-year-old Caucasian male with a past medical history significant for hepatitis C virus (HCV) infection, metastatic melanoma, and years of crack cocaine use presented to the emergency department with a one-week history of painful lesions involving the nose, limbs, and mouth. Skin exam showed painful purpura of the ears and right nasal ala, retiform purpura with necrosis of all four extremities, and an ulcer of the left buccal mucosa. His initial laboratory values were significant for microcytic anemia, decreased complement levels, and a positive drug screen for cocaine.
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