Image of the Week: Painful Lesions on the Lower Limbs and Ears

A 45-year-old woman presents with painful lesions on her lower limbs and ears. She is a smoker and has a history of recreational drug use. Purpuric, necrotic lesions are noted on both lower extremities as well as tender purpura on both ears. A biopsy is performed that demonstrates leukocytoclastic vasculitis.

Use of which substance is most likely to be associated with this presentation? Learn more about this case, take the quiz, and join the conversation on Figure 1.

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