Initial case report LINES was first described in a 54-year-old male with history of hypothyroidism who presented to an urgent care facility with bilateral axillary adenopathy and severe malaise. Incision and drainage of the nodes was performed and he was discharged home with sulfamethoxazole/trimethoprim for presumed methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient subsequently developed a temperature of 37.5 °C, expressed rigors, and night sweats. He returned to the ED the next day and on further history admitted to 3 weeks of "snorting 6–8 lines of coke a day" and smoking marijuana every evening to "come down". He was hospitalized and treated with cefepime, doxycycline, and fluconazole empirically. The next day erythematous painful papules appeared on his trunk, arms, face, and ears. Blood cultures were negative. There was prominent<unk>  of the cheek region, nose, and lips with complete sparing of the back. Skin biopsy revealed extensive small vessel thrombosis throughout the superficial and deep dermal plexuses with perivascular mononuclear inflammatory infiltrate and a few neutrophils surrounding the vessels. Erythrocyte sedimentation rate was elevated at 35 mm/hour; cardiolipin IgM was weakly positive at 16.3; C4 was decreased at 10 mg/dl; antinuclear antibodies were negative and p-ANCA was reactive. Coagulation studies were within normal limits. There was an elevated d-dimer of 17.54 mg/mL and platelets were slightly decreased. The patient's urine drug screen was positive for cannabis but not cocaine.
Levamisole induced necrosis syndrome
Metal fume fever
Adult-onset Still's disease
Relapsing fever
Polymer fume fever
Papular purpuric gloves and socks syndrome
Milk sickness
Toxic shock syndrome