October 1999


A. B.

History: The patient is a 35-year-old white male with HIV who was noted in the ER to have palpable purpura. His last CD4 count was 151 six months prior to admission. The patient was in good subjective health until the day of admission when he developed severe generalized myalgias, arthralgias, nausea, vomiting, and diarrhea.

Physical Exam: The patient was a thin, fatigued-appearing young white male in no acute distress. Temp 38.8º C, SBP 100 on dopamine drip. There were scattered purpuric macules and few papules on the bilateral proximal arms, forearms, abdomen, thighs, legs, feet, and soles. Petechiae were scattered on the legs, feet, and soles. The face, chest, and palms are spared.

Labs: WBC 16,200 with 47% bands on morphologic exam, HCT 39.70%' platelet count 62K, PT17.8, PTT46.6, normal fibrinogen and FDP, creatinine 3.0; CSF cell count 0 with protein 34 mg/dl and glucose58 mg/dI.

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