20yoF with no significant medical history presented to the E | Figure 1

BrownEM

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20yoF with no significant medical history presented to the ED with 1 week of intermittent abdominal pain, nausea, vomiting, and a non-pruritic rash on her legs. She also noted intermittent joint pain and swelling. She was seen originally at an urgent care center and treated empirically for Lyme disease without improvement in her symptoms. On further questioning, she revealed that she had a "head cold" about three weeks ago.

On exam, vitals are within normal limits. Lungs clear. Heart sounds normal. Abdomen diffusely tender but is soft. Skin exam as pictured. The rash is scattered, raised, non-blanching, and purpuric - found on her legs.

Labs show trace hematuria and a slight elevation in her creatinine.

What is the likely diagnosis? How would you manage it? Does this patient need to be admitted?

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