Correct!
4. Thrombosis from disseminated intravascular coagulation (purpura fulminans)
The skin changes are best described as retiform purpura, see the photos above. Retiform purpura is a branching (reticular), nonblanching (purpuric) patch or plaque that can occur anywhere on the body or mucous membranes. They are typically accompanied by central necrosis and/or ulceration. It differs from livedo reticularis and livedo racemosa which have partial or intermittent reduction of blood flow and are rarely necrotic.
Initial Laboratory Evaluation
- Na 128, K 3.8, Cl 98, HCO 9, BUN 27, Cr 1.8, Glu 195 (post D50 given in ED)
- WBC 3.0, Hgb 9.7, hematocrit 34.3, Platelets 65 X 106/mcL. (new thrombocytopenia)
- PT 63, INR 5.4, PTT >150
- AST 273, ALT 120
- Venous blood gases (peripheral) 7.13 / 33
- Procalcitonin 74 ng/ml (normal <0.1 ng/ml), fibrinogen 44 g/L (normal 200-465), D-dimer >7650 (normal <0.5)
- Lactic acid 10.7 mm/L
What is the most likely underlying cause(s) of her skin lesions? (Click on the correct answer to be directed to the fourth of six pages)
- Discoid lupus
- Cholesterol emboli
- Sepsis syndrome
- 1 and 3
- All of the above
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