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A 40-year-old white woman presented with a 2-week history of fever, myalgia, diffuse arthritis, and nausea and vomiting, and a 1-week history of tender, warm nodules on her lower extremities. She had undergone orthotopic cardiac transplantation 4 months earlier and had experienced multiple episodes of rejection, which required immunosuppressive therapy. Physical examination revealed approximately twenty 5- to 10-cm erythematous, warm, tender nodules on her lower extremities (Figure 1 and Figure 2) She was febrile (temperature, 39.5°C) and had arthralgias and myalgias. The findings of the rest of the physical examination were normal; in particular, there was no palpable lymphadenopathy or hepatosplenomegaly.
Laboratory tests revealed the following values: white blood cell count, 5.5 × 109/L (0.90 neutrophils, 0.06 lymphocytes, 0.03 monocytes, 0.01 basophils, and no eosinophils); hemoglobin, 85 g/L (reference range, 120-160 g/L); and hematocrit, 0.27 (reference range, 0.37-0.47). The results of a routine chemistry profile were within normal limits except for the lactate dehydrogenase level, which was elevated at 1031 U/L (reference range, 300-600 U/L). Additional evaluation included radiography of the chest; computed tomography of the brain, abdomen, and pelvis; endoscopy of the upper and lower gastrointestinal tract; and biopsies of the stomach and small bowel; the results were unremarkable. An 8-mm punch biopsy specimen was obtained from a lesion on the left thigh (Figure 3).
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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