A Puzzling Case of Persistent Purpura

D I ght t the s as r an p s v p s RESENTATION 21-year-old woman presented to the emergency dep ent with a history of flank pain, gross hematuria, and esions. The right-sided flank pain began 4 days prio resentation and did not radiate. She also developed rbital bruises, identical to those experienced 7 mo arlier when she had been diagnosed with biopsy-pro eukocytoclastic vasculitis. A review of systems was notable for subjective fe hills, and night sweats. Additional medical history inclu ephrolithiasis, migraine headaches, and cold urticaria. Vas itis and associated tender skin lesions were treated with m trexate, 10 mg weekly, and prednisone, 6 mg daily; m rexate minimized prednisone use. Sumatriptan was used eeded for headaches. The patient was a graduate student studying rehabi ion psychology and was engaged to be married. She d se of tobacco, alcohol, and recreational drugs, and she ot traveled abroad. There was no family history of mmune disease, bleeding disorders, or renal disease.