A 60-yr-old with diarrhea and a worsening non-pruritic rash
A 60-year-old man with a history of gastroesophageal reflux disease (GERD) presents to the emergency department with 2 to 3 days of fever, non-bloody diarrhea, and a worsening non-pruritic rash. He recently traveled to Mexico on a cruise where he ate some local food and may have been bitten by mosquitos. He denies vomiting or abdominal pain, and a review of his other systems is otherwise normal.

Vitals signs are all normal except for an oral temperature of 101.8° F. His eyes are clear, and his oropharynx is moist without lesions. His heart and lungs are normal to auscultation, and his abdomen is benign without tenderness. He has an impressive rash that is most severe on his legs and is non-blanching.

Complete blood count, Chem7, and liver function test are all normal. C-reactive protein and erythrocyte sedimentation rate (ESR) were both elevated at 82 and 61, respectively.

The patient is most likely suggering from leukocytoclastic vasculitis which is an uncommon inflammatory condition affecting small arteries in the skin that typically is limited to the lower extremities and does not affect internal organs as many other types of vasculitis do.

The rash is typically impressive in appearance but is not painful and does not ulcerate. Causes can be categorized as follows: various collagen-vascular diseases, cancer, various infections, cryoglobulinemia, and medications, with each of these having a number of etiologies.

Stool culture, complement level testing was done. The complement levels were found to be low (C3 slightly low at 70, and C4 undetectable), supporting a diagnosis of vasculitis. Additional testing ruled out involvement of other organs. The patient gradually improved with conservative management.

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