Correct!
3. Sepsis syndrome
There are many causes of retiform purpura and in this patient's presentation, she has several potential causes. The most likely is intravascular occlusion related to disseminated intravascular occlusion (DIC) and when presentation is widespread, it is called purpura fulminans. Another potential cause in this patient is a hypercoagulable state such as from catastrophic anti-phospholipid syndrome, antithrombin III deficiency, protein C/S deficiency, prothrombin III mutation, factor V Leiden or hyperhomocysteinemia.
Purpura from cryoglobulinemia due to hyperviscosity and blood vessel occlusion can occur as well as cryofibrinogenemia resulting from the precipitation of fibrin, fibrinogen also due to cold exposure. Both cryoglobulinemia and cryofibrinogenemia purpura tend to occur in acral or peripheral parts of the body.
A portable chest x-ray was taken post intubation in the ICU (Figure 2).
Figure 2. Portable chest x-ray taken after intubation in the ICU.
This patient had bacteremia twice with Streptococcus pneumoniae within two months. What statements are correct? (Click on the correct answer to be directed to the fourth of six pages)