History: 45 year old African-American female presents with diffuse arthralgias and a one day history of nausea, vomiting, fever, diarrhea, abdominal pain, and a rash on legs.
Physical Examination: Non-blanching stellate purpura and distal cyanosis of both lower extremities (Figs. 1,2).
Hemoglobin, hematocrit, red and white blood cell counts: normal
Platelets: 42 (normal 140-440)
Fibrinogen: 337 (normal)
CSF protein: 75 (normal 15-45)
CSF nucleated cells: 44 (11% neutrophils, 72% lymphocytes, 5% monocytes, 9% macrophages)
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