PMC4501505_01
ICU admission chest X-ray: consolidation at right base; perihilar pulmonary congestion. CT chest: right middle lobe and right lower lobe pneumonia.
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ICU. Initial chest X-ray and CT scan revealed right middle and lower lobe pneumonia (See Figs. 1 and 2).
Image of skin findings: diffuse maculopapular rash with dark necrotic-appearing areas.
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ICU. Initial chest X-ray and CT scan revealed right middle and lower lobe pneumonia (See Figs. 1 and 2).
Skin biopsy histopathology: partial fibrin thrombi in small, superficial vessels as wells as larger mid-dermal vessels.
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Twenty-four hours into hospitalization, the patient's rash became more confluent, with dark necrotic-appearing areas (see Fig. 3), and spread to involve the arms, legs, trunk, tip of the nose and left ear along with acral cyanosis.
Skin biopsy histopathology: fibrinoid degeneration of the vessel walls.
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Histopathology revealed partial fibrin thrombi in small, superficial vessels as well as larger mid-dermal vessels and fibrinoid degeneration of the vessel walls, overall consistent with a coagulopathy (see Fig 4).