PMC7165345_01
Nonvesicular, purpuric macular rash distributed over the patient's anterior and posterior regions of his right buttock (not shown) and right lower extremity. The rash was not confined to a dermatomal distribution. Pathology of the rash was consistent with leukocytoclastic vasculitis.
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Physical examination was notable for the absence of a cardiac murmur, 2/5 right lower extremity weakness, and painless purpuric macules scattered along the anterior and posterior regions of his right buttock and right lower extremity in a nondermatomal distribution without vesicles (Figure 1).
MRI with intravenous contrast of the brain and spine showing subacute infarcts in the bilateral cerebral hemispheres and left cerebellar hemisphere (a) and an enhancing lesion within the posterior aspect of the right hemicord at the T5 level (b).
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Magnetic resonance imaging (MRI) with intravenous contrast of the brain and spine was notable for subacute infarcts in the bilateral cerebral hemispheres and left cerebellar hemisphere (Figure 2(a)) and an enhancing lesion within the posterior aspect of the right hemicord at the T5 level (Figure 2(b)).
Repeat MRI with intravenous contrast of the spine demonstrating an increased T2 signal at the T5-T6 level of the spinal cord consistent with infarct.
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However, 9 days after discharge, he presented again to the emergency room with an acute onset of left leg weakness in the absence of rash and was found to have a new spinal cord infarct at the T6 level on MRI (Figure 3).