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This 15 year old boy presented with purpuric spots on his lower limbs, ankle pain, and swelling. On examination he was found to have hypertension, and although Henoch-Schönlein purpura was felt to be the more likely diagnosis, the absence of femoral pulses was perplexing. For this reason we considered an infected coarctation which would explain all the presenting features. Investigations revealed microcytic anaemia, raised C reactive protein, haematuria, and Streptococcus viridans on blood culture. Echocardiography confirmed the coarctation and magnetic resonance imaging the infected proximal aneurysm, which was later successfully resected.
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