Purpura and Gangrene in a Septic Patient

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Abstract
REPORT OF A CASE A 63-year-old previously splenectomized woman developed fever, shortness of breath, and a dry, nonproductive cough. She was admitted to a local hospital where her condition rapidly deteriorated. On admission to our institution, the patient appeared gravely ill and was in septic shock. A chest roentgenogram showed bilateral lower lobe infiltrates, and multiple blood cultures were positive for Streptococcus pneumoniae. Laboratory data were as follows: white blood cell count, 41.0 × 109/L; platelet count, 32.0 × 109/L; markedly prolonged prothrombin and partial thromboplastin times; low-normal fibrinogen levels; and circulating fibrin degradation products. Cutaneous examination showed widespread ecchymoses, hemorrhagic bullae, and dry gangrene of the digits on the hands and feet (Figs 1 and 2). A punch biopsy specimen was obtained from an ecchymotic area and showed epidermal necrosis with cleft formation between the epidermis and dermis. In addition, extravasated red blood cells were scattered throughout the