An 81-year-old outdoorsman from northern New York with a history Henoch–Schonlein purpura presented with 2 weeks of worsening shortness of breath, oliguria, and a bilateral lower-extremity purpuric and petechial rash with circinate lesions on his left dorsal foot. The symptoms and rash did not improve after broad-spectrum antibiotics for presumed pneumonia and systemic corticosteroid administration for a presumed vasculitis flare. A skin biopsy showed a leukocytoclastic vasculitis with negative IgA immunofluorescence. A chest computed tomography showed bilateral cavitary lung nodules. Further blood testing was performed to confirm the diagnosis.