Derm Dx: Neutropenia and purpura in a cocaine user

A 36-year-old female presents complaining of fever and of tender purplish patches on her ears and trunk. She denies any prior medical problems, prescription medication use, or drug, tobacco or alcohol use.

A urine toxicology screen is positive for cocaine. Other significant labs include neutropenia and a positive P-ANCA. Platelet, fibrinogen and D-dimer levels are normal.