Description
A 22-year-old woman underwent normal vaginal delivery; 3 days later, she developed fever and rashes over all four limbs followed by decreased urine output. Examination revealed pedal oedema, non-palpable purpuric lesions over extremities with erosions at few places, and blackish discolouration of second and third toe of right foot (figure 1A). On investigation, haemoglobin was 6.7 g/dL, white blood cell 26 200/mm3, platelet 39 000/mm3, prothrombin time 25 s (control 12–14 s), activated thromboplastin time 38 s (control 24–30 s) and serum creatinine 9.1 mg/dL. Urine showed albumin 1+. Ultrasound was suggestive of bilateral acute renal parenchymal disease. Work-up for tropical infections was negative. Clinical diagnosis of puerperal sepsis causing purpura fulminans and acute kidney injury was made.
Figure 1
Clinical photograph showing multiple non-palpable purpuric lesions over extremities with erosions at few places and blackish discolouration of toes (A). CT scan of abdomen showing acute bilateral renal cortical necrosis (B).
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