A 48-year-old woman presents with a 3 month history of severe asthma, accompanied for the past week by a skin rash. She has also noted numbness in her fourth and fifth fingers of her right hand. She has been running a low grade fever, and complains of malaise and a recent unintended weight loss of 10 pounds. She is a non-smoker, and has no history of diabetes mellitus. Physical examination reveals bilateral wheezes, diminished sensation to pin over her right 4th and 5th finger and lateral palm, and scattered palpable purpura (pictured). She has an absolute eosinophilia (1,500 cells/uL) and an elevated ESR.
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