Acute Purpura Fulminans Skin Rash on Physical Exam 60 year old male ITP s/p splenectomy 1d chills/rigors, diarrhea, nausea. 2hrs later, develops a new full-body rash. No sick contacts, travel. Recent tick bite. Cat at home. No raw seafood. Admitted to ICU in multipressor shock. Ddx? Ddx is very broad! A key here is what can lead to the rash (purpura fulminans) and critical illness. Here are a few leading thoughts on the list: Strep pneumo, N.meningitidis, Vibrio, aeromonas, Capnocytophaga, RMSF Another pit stop here to think about high risk pathogens in setting of asplenia. Your blood cxs identify GNR and pt slowly improving on abxs. Final dx: Septic shock, multiorgan system failure, purpura fulminans secondary to Capnocytophaga! - BIDMC Infectious Diseases Fellowship @BIDMC_IDFellows #Capnocytophaga #Purpura #Fulminans #Skin #Rash #clinical #photo
