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A 61-year-old man presented with fatigue, arthralgias and a tender rash on his ears in the setting of recent cocaine use. Physical examination revealed purpuric dark purple patches with haemorrhagic bullae on the bilateral helical rims (figures 1 and 2). Laboratory investigation was significant for a serum sodium of 130 mmol/l (normal range, 135–145) and positive perinuclear antineutrophil cytoplasmic …
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