Red Book Online Presents: Diagnosis Detective | August 2024
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Vini Vijayan, MD, FAAP, FIDSA, Valley Children's Healthcare, Madera CA
A 16-year-old previously healthy male presents with 2 months of intermittent fever, cough, myalgia, and a rash on the lower extremities. The physical examination is notable for rales heard over the right lower lobe and tender, violaceous nodules on the bilateral lower extremities. A chest X-ray reveals consolidation of the right lower lobe. The patient lives in a rural setting in central California and engages in outdoor activities. He denies any recent travel, animal, or tuberculosis exposures.
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