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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 …
Contributors VM and AM collected and analysed the data and drafted the report. AM provided care for the patient. SVC and MGS analysed the data and revised the manuscript for important intellectual content. All authors approved the final version.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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