01717nam a2200289   4500001000800000005001700008007000300025008004100028040000800069041000800077100003800085245007700123300002500200520073700225650003200962650003800994650003401032650004601066650003401112700002801146700002701174700003201201700003601233773011001269942003101379999001701410ESSALUD20260903155106.0ta      t        pe ||||| |||| 00| 0 spa d  aBMG  aeng  aCortazar, Frank B. eAutor954604  aCase 13-2026: A 76-Year-Old Woman with Fatigue, Rash, and Kidney Failure  apáginas: 1737-1748  aA 76-year-old woman was transferred to the medical service of this hospital because of rapidly progressive kidney failure.
The patient had been in her usual state of health until 1 year before the current presentation, when a painless purpuric rash on the lower legs developed. The rash waxed and waned. There was no joint pain, edema, weakness, or weight loss. The patient was seen by a dermatologist at another hospital, and the results of a skin biopsy were reportedly consistent with leukocytoclastic vasculitis. The results of urinalysis and kidney-function tests were normal. Her symptoms were attributed to a history of hepatitis C virus (HCV) infection; topical glucocorticoid treatment was initiated, and the rash resolved.  aLESIÓN RENAL AGUDA933639  aMEDICINA CLÍNICA GENERAL953666  aDERMATOLOGÍA GENERAL954449  aENFERMEDADES INFECCIOSAS GENERALES954087  aREUMATOLOGÍA GENERAL954450  aSise, Meghan E. 954605  aRapalino, Otto 954606  aBranagan, Andrew R. 954607  aTrivin-Avillach, Claire 9546080 022717922684dMassachusetts NEJM GroupoNEJM016tThe New England Journal of Medicine wESSALUDx0028-4793  cARTICULOSe2026-08-31zsqb  c22935d22935