An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.
A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. Patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.
Ontachi
Yasuo
Y
Department of Internal Medicine (III), Kanazawa University School of Medicine, Takaramachi 13-1, Kanazawa 920-8641, Japan. onta@yu.incl.ne.jp
Asakura
Hidesaku
H
Funada
Hisashi
H
Takami
Akiyoshi
A
Saito
Masanori
M
Morishita
Eriko
E
Yamazaki
Masahide
M
Mizutani
Tomoe
T
Kaneda
Minori
M
Ito
Takako
T
Nakao
Shinji
S
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000209:etiology; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005145:Face; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology / Q000473:pathology; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008297:Male; D009336:Necrosis; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D005337:Fibrin