Hospital Course -- Fever, Purpura and Hypotension

LABORATORY DATA (upon admission to UPMC):

Peripheral Blood
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


GRAM STAIN OF SKIN LESION: Rare gram-positive cocci in pairs and clusters


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


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