57-year-old woman with purpura fulminans and acute kidney injury

Clinical presentation A 57-year-old woman was admitted to Peking University First Hospital with a fever (temperature 38.5°C), and a 5-month history of a systemic purpura-like rash. Four days before admission, the rash worsened after exposure to cold weather for around 4 hours during a trip and involved the skin on her feet, ankles to thighs, buttocks and face (figure 1A–C). She had suffered from repeated but progressive ankle pain and fatigue over the previous 2 years. The initial laboratory investigations showed IgG 18.5 g/L (normal 7.23–16.85) and erythrocyte sedimentation rate (ESR) 41 mm/hour (0–19). The white blood cell count was 10.97x109/L (normal 3.5–9.5), haemoglobin was 115 g/L (115–140), platelets were 258x109/L (100–350). The urine albumin-to-creatinine ratio was 414.22 mg/g (<30) and urinary red cell count was 56.9 per high-power field. Serum creatinine (SCr) increased from 37.1 to 155 μmol/L (44–133) the day following hospitalisation, and progressed...
Source: Journal of Clinical Pathology - Category: Pathology Authors: Tags: JCP Education, COVID-19, Grand rounds Source Type: research