10-09-2008, 11:38 AM
A 52-year-old woman presented to the emergency department reporting a 1-week history of rash on her bilateral lower extremities and "spots under her tongue." She noted no similar rashes in the past nor any recent trauma, viral infection, fever, sick contacts, overt bruising, hematuria, melena, hematochezia, epistaxis, gingival bleeding, or menorrhagia. Her medical history included lupus, congestive heart failure, hypertension, hypothyroidism, and anemia of chronic disease.
Physical examination revealed petechiae over her bilateral lower extremities as well as palatal and subungual petechiae (Figures 1, 2). The lesions were asymptomatic and the remainder of her physical examination was normal. Laboratory studies revealed a white blood cell count of 4,000/μL (normal, 4,500-11,000/μL); hemoglobin of 10.7 g/dL (normal, 12.0-15.0 g/dL), which was a stable level compared with her baseline; hematocrit of 35.9% (normal, 35%-45%); and a platelet count of 6 x103/μL (normal, 14-40 x103/μL). Her liver function tests, Epstein-Barr virus titer, human immunodeficiency virus test, and hepatitis panel were all negative.
What's Your Diagnosis?
1.Chronic disseminated intravascular coagulation
2.Idiopathic thrombocytopenic purpura
3. Leukocytoclastic vasculitis
4. Meningococcemia
Physical examination revealed petechiae over her bilateral lower extremities as well as palatal and subungual petechiae (Figures 1, 2). The lesions were asymptomatic and the remainder of her physical examination was normal. Laboratory studies revealed a white blood cell count of 4,000/μL (normal, 4,500-11,000/μL); hemoglobin of 10.7 g/dL (normal, 12.0-15.0 g/dL), which was a stable level compared with her baseline; hematocrit of 35.9% (normal, 35%-45%); and a platelet count of 6 x103/μL (normal, 14-40 x103/μL). Her liver function tests, Epstein-Barr virus titer, human immunodeficiency virus test, and hepatitis panel were all negative.
What's Your Diagnosis?
1.Chronic disseminated intravascular coagulation
2.Idiopathic thrombocytopenic purpura
3. Leukocytoclastic vasculitis
4. Meningococcemia