Case Challenge #8

A 42 year old female presents with fever, rash, and worsening shortness of breath.  She has chronic asthma, and during a recent PCP visit, she was started on Montelukast and tapered off steroids.

On physical exam, she has a fever, with Tmax 102 F. Her heart rate is in the low 100s, with a BP of 150/90, RR of 20 (really), and an O2 sat of 90%. Pulmonary exam reveals prominent bilateral wheezing with decreased air movement. Cardiovascular exam is unremarkable, as is the abdominal exam. She has palpable purpura on both of her legs. Neurologic exam reveals foot drop on the right.

Labs reveal a leukocytosis, with 18k white blood cells (15% of which are eosinophils). CRP is elevated to 120. Renal function and liver function test results were normal. Urine microscopy did not reveal any active sediments.

Chest X-Ray

 CT chest

CSCT

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