Solve exciting clinical cases specific to your field of interest via Docplexus’ Clinical Case Challenge. Join your fellow doctors to discuss and answer today’s challenge! Case presentation A 55-year-old man presented to the emergency room with hepatitis C virus (HCV) infection and bilateral hand pain with a diffused purpuric rash. He also complained of arthralgias, weakness, and numbness.
Physical examination Palpable purpura Extensive gangrene in the upper and lower extremities (Cover image a and b) Laboratory investigation Positive for rheumatoid factor (>1.200 IU/mL) Hypocomplementemia (C4<8.0 mg/dL) HCV RNA - 2,390,000 IU/mL Skin biopsy of leg Mixed, predominantly acute, infiltrate showing scattered small to mid-sized vessels with features of fibrin thrombi. Treatment Plasmapheresis was initiated. However, gangrene continued to worsen. Therefore, immunosuppressive therapy and…
