LABORATORY DATA (upon admission to UPMC):
| White Blood Cells | 11.3 x 10E+09/L |
| Neutrophils | 35 % |
| Bands and Immature Forms | 52 % |
| Lymphocytes | 10 % |
| Hemoglobin | 10.8 g/dL |
| Hematocrit | 30.6 % |
| Partial Thromboplastim Time | 87.9 sec (nl 20-30) |
| Prothrombin Time | 18.1 sec (nl 11.2-14.4) |
| Platelets | 58 x 10E+09/L |
| Sodium | 134 meq/L |
| Potassium | 4.8 meq/L |
| Creatinine | 3.6 mg/dl |
| Glucose | 51 mg/dl |
| Amylase | 249 mg/dl |
| DIC Screen | Positive for active DIC |
WBC MORPHOLOGY: Neutrophils contain intracellular bacteria and there is vacuolization of neutrophils and lymphocytes. Atypical lyphocytes are also seen.
URINE: WBCs, RBCs, nitrite, leukocyte esterase, and occasional bacteria present
URINE CULTURE: No growth
GRAM STAIN OF SKIN LESION: Rare gram-positive cocci in pairs and clusters
ICU COURSE:
The patient was given penicillin G, ceftriaxone, and rifampin. Despite maximum support the patient went into electromechanical disassociation and expired approximately 18 hours after initial presentation to the outside hospital.
Final Diagnosis