Case 14-2017: A 20-Year-Old Man with Pain and Swelling of the Left Calf and a Purpuric Rash

A 20-year-old man with a history of Crohn’s disease was evaluated for pain and swelling of the left calf and a purpuric rash. Three weeks earlier, sore throat, cough, rhinorrhea, and chills had developed. Diagnostic tests were performed. Presentation of Case Dr. Lauren R. Zeitels (Medicine): A 20-year-old man was seen in an outpatient clinic of this hospital because of pain and swelling of the left calf and a purpuric rash. The patient had been well until 3 weeks before presentation to this hospital, when sore throat, nonproductive cough, rhinorrhea, and chills developed. He noted areas of crusting and occasional bleeding in both nares (Figure 1). His brother had reportedly received a recent diagnosis of streptococcal pharyngitis. Two weeks before presentation to this hospital, the patient had traveled by airplane to the northwestern United States for a wilderness . . .