E.H, a 29-year-old Mother of Two

E.H, a 29-year-old mother of two was admitted to the emergency room with symptoms of shortness of breath and a nonproductive cough. She also complained of chills, fever, appetite loss and weight loss of 10 pounds over a 2-week period. E.H is a college graduate and worked as CPA prior to staying home to raise her children, while her husband worked full time. On physical examination, oral whitish lesions on the buccal mucosa were present, and fine crackles on the lower half of the lung fields with inspiratory and expiratory rhonchi were heard. E.H had the flu a few months ago and thought her symptoms were related to the flu. E.H.’s husband informed the Dr. that his wife appeared confused at times. Painful purple-brown nodules were noted to be 1mm-1cm in diameter on the skin. The nodules were on her arms and legs. Generalized lymphadenopathy was noted along with engorgement of retinal arteries upon retinal exam. Pupillary edema and hemorrhage were also noted.
E.H.’s vital signs were within normal range except for a fever of 102. Initial lab tests included complete CBC with most results close to normal range. A Buccal smear was done. After reviewing the results, the NP decided to order additional tests.

What is the diagnosis?
What is the exact cause of EH’s confusion?

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