A 68-year-old woman was admitted to intensive care unit with respiratory failure and hypotension. Her blood pressure was 70/50 mmHg and heart rate was 125 bmp. Examination Physical examination revealed skin mottling on the legs (first image). Laboratory values noted as follows: Arterial-blood lactate level of 4.5 mmol / liter (normal value, <2.0) Cardiac troponin T level of 0.43 ng / milliliter (normal value, <0.014) N-terminal pro–brain natriuretic peptide level of 24,500 pg / milliliter (normal value, <900) PCR assay for adenovirus in bronchoalveolar lavage blood: Positive No other viruses or bacteria were found.
Transthoracic echocardiography indicated a left ventricular ejection fraction of 25%. What is the most likely etiology of the skin mottling? *This case is from Docplexus editorial team for education purpose only. Source: NEJM
