Medical image of the week: purpura fulminans

• Main Authors: Power EP, Beatty N, Natt B
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2016-12-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: purpura fulminans; sepsis; skin; mottling; disseminated intravascular coagulation; DIC; prognosis; protein C deficiency; ecchymosis; thrombosis
• Online Access: http://www.swjpcc.com/imaging/2016/12/14/medial-image-of-the-week-purpura-fulminans.html

No abstract available. Article truncated at 150 words. A 54-year-old man with coronary artery disease, fibromyalgia and chronic sacral ulcers was brought to the emergency department due to acute changes in mentation and hypotension. He suffered a cardiac arrest shortly after arrival to the emergency department during emergent airway management. After successful resuscitation, he was admitted to the medical intensive care unit and treated for septic shock with fluid resuscitation, vasopressors and broad spectrum antibiotics. Laboratory results were significant for disseminated intravascular coagulopathy (DIC)- thrombocytopenia, decreased fibrinogen and elevated PT, PTT and D-dimer levels. Profound metabolic acidosis and lactate elevation was also seen. Blood Cultures later revealed a multi-drug resistant E. coli bacteremia. Images of the lower extremities (Figure 1) were obtained at initial assessment and are consistent with purpura fulminans. He did not survive the stay. Purpura fulminans, also referred to as skin mottling, is an evolving skin condition which is characterized by an acutely worsening reticular …