59-year-old man presented with red, tender papules on his back that had developed after he had begun a prednisone taper. He had taken prednisone daily for some time for multiple systemic symptoms. History. The patient had been in the care of a rheumatolo-gist, a nephrologist, and a pulmonologist for granulomatosis with polyangiitis (GPA). His symptoms at the time of diagnosis had included persistent nasal crusting and discharge, dyspnea, hemoptysis, arthralgia, oliguria, and dysuria. Laboratory test results at the time of diagnosis had included a cytoplasmic an-tineutrophil cytoplasmic antibody (c-ANCA) screening titer greater than 1:640, an erythrocyte sedimentation rate (ESR) of 79 mm/h, and a C-reactive protein (CRP) level of 69 mg/L. Bronchoscopy and renal biopsy results did not reveal characteristic histologic findings.
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