Strength of recommendation (SOR)
A. Good-quality patient-oriented evidence
B. Inconsistent or limited-quality patient-oriented evidence
C. Consensus, usual practice, opinion, disease-oriented evidence, case series
A 49-year-old man with a history of hypertension, hypercholesterolemia, polysubstance use, recurrent methicillin-resistant Staphylococcus aureus skin infections, and chronic hepatitis C infection sought care at our emergency department (ED) because parts of his ears had started turning black 3 days earlier. They were also painful to the touch. He denied fever, any similar skin lesions, injury to his ears, or a history of easy bleeding or bruising. A recovering alcoholic, he admitted to regular marijuana use and twice-weekly cocaine use. He had last used cocaine 3 days ago.
The patient was thin and in no acute distress. His vital signs and cardiopulmonary exams were normal. Examination of his ears revealed bilateral violaceous firm, tender purpura on the pinnae (FIGURE).
A complete blood count (CBC) revealed mild leukopenia (white blood cell [WBC] count, 2.0 × 109/L), neutropenia (0.9 × 109/L), and a normal platelet count (264 × 109/L). A chemistry panel, liver function tests, and prothrombin time were normal. Erythrocyte sedimentation rate (ESR) was elevated to 69 mm/h. The patient’s cholesterol level was not elevated. Urine toxicology was positive for cocaine and opioids. A human immunodeficiency virus test was negative.
Figure
Tender purpura on the pinnae
What is your diagnosis?
How would you treat this patient?