A 46-year-old married woman presented with sepsis and purpura. The patient had an abrupt onset of fevers, rigors, and progressive altered mental status. She was transported to the emergency department by ambulance where she was found to be hypotensive and, after initial stabilization, was moved to the intensive care unit. Initial evaluation did not reveal an obvious source for the sepsis.
Medical history: splenectomy after a motor vehicle accident 15 years earlier; hypertension; Medications: hydrochlorothiazide; No known allergies, owner of 3 dogs. Diet: regular Physical examination Vital signs: temperature: 103.1°F, pulse: 140 beats/minute, respirations: 20 breaths/minute, blood pressure: 80/60 mm Hg on norepinephrine bitartrate. General: ill-appearing; HEENT: normal; Lungs: clear; Heart: normal;Abdomen nontender, no rebounding or guarding; Extremities cool and mottled. A few…
