What’s causing this purpuric rash?

James, 44, presents with a non-pruritic rash on his legs for the past three days.

The rash appears to be spreading.

He currently feels well, though reports two weeks ago he had a fever for a few days, with aching joints.

He is generally well and takes no regular medications.

Examination findings are unremarkable, apart from a palpable purpuric rash (pictured below) and urinalysis, which is blood- and protein-positive.

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Dr Paul Muthiah is a GP on the Central Coast and medical co-editor at Australian Doctor.