A 50-year-old diabetic female has been admitted to your unit with worsening gas exchange in the setting of precipitous hypotension and acute confusional state requiring initiation of mechanical ventilation and inotropic and vasopressor support. She is febrile with deranged liver and renal function. She has anaemia and profound thrombocytopenia, and a widespread rash (see Figure 15.1 below).
List four likely causes to account for these findings. (40% marks)
This question resembles Question 14.2 from the second paper of 2010, and - though the original rash image is absent from the college paper- a reasonable replacement can be found if one searches for "purpura fulminans" in Google Images. The patient comes with a history of:
Thus, TTP and sepsis with MOSF and DIC have to be somewhere in the four answers. For a more complete list of possibilities, an excellent review presents a breakdown of the differential causes of puprura fulminans, which include the following:
Gürses, Nuran, and Ismail Ilek. "Causes of purpura fulminans." The Pediatric infectious disease journal 14.6 (1995): 552.
Spicer, Thomas E., and Jerold M. Rau. "Purpura fulminans." The American journal of medicine 61.4 (1976): 566-571.
Chalmers, E., et al. "Purpura fulminans: recognition, diagnosis and management." Archives of disease in childhood 96.11 (2011): 1066-1071.