Pink urine and a petechial rash.

Abstract

QUESTIONS: A 52-year-old Hispanic woman with a long history of bilateralknee pain and type 2 diabetes mellitus sees her family physician because inthe past 4 days she has had pink urine, generalized malaise, and a rash on herhands and feet. On physical examination, the patient has oral and lingular submucosalhemorrhages (figure 1),injected sclerae with subconjunctival bleeding, and tenderness of both knees.She also has a vesiculomacular rash with a dark erythematous base that isclustered and more severe on her legs than on her arms(figure 2). She has sparsepinpoint macular lesions on her torso. Her temperature is 38.3°C(101°F), and she has a new ejection systolic murmur at the left uppersternal border. On reexamination several hours later, the number of lesions onher legs has increased. Figure 1 Submucosal hemorrhages and diffuse petechiae on oral and lingularsurfaces Figure 2 Vesiculomacular rash with a dark erythematous base What additional questions would you ask this patient, and what other partsof the body would you examine? What kind of skin lesions are these, and whatis your differential diagnosis? What tests would help make the diagnosis? Whatis the diagnosis, and how would you treat it?