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Seventy-five-year-old woman with month-long fever, cavity lung lesions and cutaneous ulcer
  1. Chang-Han Wu1,2,
  2. Chi-Wei Chen1,2
  1. 1 Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
  2. 2 Emergency Department, Kaohsiung Medical University, Kaohsiung, Taiwan
  1. Correspondence to Dr Chang-Han Wu, Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, No.100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan (R.O.C.), Taiwan; i54016296{at}

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Clinical Introduction

An elderly Asian woman presented to the ED with month-long fever, rhinorrhea and productive cough. She subsequently developed tender bruise-like skin nodules over her trunk and limbs, which quickly progressed to form cavity ulcers 2 weeks before ED visit (figure 1). Despite various antimicrobial therapies, her symptoms did not improve. Laboratory tests showed leukocytosis, elevated C reactive protein, proteinuria and haematuria. Initially, a chest radiograph (online supplemental material, figure 1) was performed to exclude pneumonia, which revealed bilateral lung lesion, prompting further investigation with chest CT (figure 2). The result revealed bilateral lung cavity and nodular lesion.

Supplemental material

Figure 1

Rapid progress of the skin lesion and …

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  • Contribution statement: All authors contributed to the care of the patient. C-HW provided the study conception and design and drafted the manuscript. C-WC was responsible for editing the article and gave final approval to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.