A 78-year male patient with personal history of asthma, hype | Figure 1

A 78-year male patient presentation

A 78-year male patient with personal history of asthma, hypertension and type 2 diabetes mellitus presented with 3 days history of fever up to 38°C, weakness, fatigue. He didn't have other complaints. On the day of visit, he noticed rash on his both lower legs, he started to feel pain in his legs, and he vomited 3 times. His glucose level was 10.3 mmol/L. PHx is positive for metal implant in his left leg after car accident many years ago - from that time he has swelling of the left leg and few years ago he had cellulitis of the lower part of the leg. From that time he has chronic skin changes of that leg. He had MI 10 years ago. His therapy includes prenidopril, bisoprolol, gliclaside, metformin and lerkadipin. On exam he was awake, fatigued, obese, with low-grade fever (37.5°C), with swelling of left lower leg and petechial and non-palpable purpuric lesions. He has heart murmur above apex and Erb's point and also inspiratory crackles above left lung base. The rest of exam was normal. Chest X-ray and abdominal US was normal. Labs: WBC 3.79; ly. 0.58; CRP 61.3; glucose 9.7; BUN 10.8; creatinine 210; D-dimer 2.25. Urine: Hb +/-. The rest of labs was within normal limits. The patient was admitted to hospital. On the next day rash appeared on upper legs and abdomen. My working diagnosis is some kind of vasculitis. Your opinion?

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