October 2006





History & Physical Exam:

A 20 year old African american female presented to the emergency room for a one day history of malaise, myalgias, chills, sore throat, fever, photophobia, diarrhea, neck stiffness, headache, chest pain and "bruise on leg." The patient was in her usual state of health until the day prior to presentation. On exam, the patient was lethargic, complaining of chest pain with a blood pressure of 89/36. She had a faint purpuric rash and scattered petechiae onthe lower extremeties (Fig.1, 2).

Labs: WBC: 27K PLT: 223 PT: 31 INR: 1.23 PTT: 31

Skin biopsy was performed.

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