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Philip A. Mackowiak, New-Onset Purpura in a Patient with Recently Diagnosed Temporal Arteritis, Clinical Infectious Diseases, Volume 37, Issue 2, 15 July 2003, Pages 238–240, https://doi.org/10.1086/375874
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An 81-year-old woman from Kentucky presented with a 1- week history of increasing abdominal discomfort, nausea, and vomiting. She had a long history of “stomach ulcers” and recently had temporal arteritis diagnosed. At admission to our hospital, her temperature was 36.8°C, her pulse was 68 beats/ min, and her blood pressure was 119/46 mm Hg. She had mild abdominal tenderness but no peritoneal signs. Her leukocyte count was 18,100 cells/¼L, with 76% neutrophils, 13% band forms, 4% lymphocytes, and 7% monocytes. She underwent hydration, prednisone therapy was continued, and levofloxacin therapy was commenced to treat a presumed urinary tract infection. The patient's condition deteriorated over the next week, and she developed marked abdominal discomfort, worsening leukocytosis, and extensive petechial and purpuric exanthem of the abdomen and thighs (figures 1 and 2). The patient's platelet count was 142,000 platelets/¼L. Findings of a CT scan revealed intramural air in the right colon. The patient underwent subtotal colectomy with ileostomy for possible ischemic colitis and skin biopsy of the rash. Despite institution of appropriate therapy, her condition did not improve, and she died on day 23 of hospitalization. Histopathologic evaluation of skin and colon specimens revealed the findings illustrated in figures 3 and 4.
