A 74-year-old man presented with skin rash developed few hours before. He complained of continuous fever since the past five days. Other symptoms Headache, myalgia and productive cough Altered sensorium observed in the form of decreased speech and irritable behaviour No cardiorespiratory, gastrointestinal or renal complaints.
Observations Symmetric purpuric rash involving palms, soles, arms and legs Over 48 hours, the rash turned bullous, confluent, black and necrotic. History Medical: No history of diabetes or hypertension Personal: No addiction to tobacco or alcohol Examination Irritable and disoriented Pedal edema Temperature- 38.8 0 C Pulse- 104 beats/min BP- 90/60 mmHg Respiratory rate- 24/min Lab investigations Hb– 12 g% Total leukocyte count– 21 x 10 9 /L Platelet count– 18 x 10 9 /L Blood urea– 160mg/dL Serum creatinine– 2.6 mg/dL D-dimer– 400 ng/mL Total/Direct bilirubin– 3/2.8…
