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A 68-year-old woman presented with skin lesions for 1 week. She reported similar lesions 6 months before, which had resolved within a few weeks. Physical examination showed haemorrhagic lesions over forearms and face with bullae (figure 1A,B). Laboratory tests revealed pancytopaenia with neutropaenia. Antinuclear antibody, perinuclear antineutrophil cytoplasmic antibody (p-ANCA), antiproteinase-3 (anti-PR3) and antimyeloperoxidase (anti-MPO) antibodies were positive with high titres. Complement levels were normal. Cryoglobulin and rheumatoid factor were negative. Urine toxicology screen was positive for cocaine. Skin biopsy showed leukocytoclastic …
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