Clinical Case Scenario
A 36-year-old female presented with history of 1 day of fever associated with rash, and breathlessness, rapidly progressing to severe metabolic acidosis, refractory septic shock requiring multiple vasopressors, acute kidney injury, and disseminated intravascular coagulopathy with multi-organ dysfunction. Physical examination revealed multiple petechial patches (Figure 2) all over the body. Despite aggressive management, including intubation, mechanical ventilation, broad-spectrum antibiotics, and fluid resuscitation, the patient's condition deteriorates, ultimately leading to cardiac arrest and death within 36 hours of ICU admission.
A POCUS of the abdomen of this patient during resuscitation revealed the findings which are shown in figure 1. A screening echo was normal with good left ventricular systolic function. Preliminary blood culture findings show gram-negative diplococci.
Which of the following conditions best describes the rapidly progressive shock and widespread purpuric rash?
Figure 1: POCUS scan of right adrenal gland
(Case courtesy of Mohammad walid Ahmad Amin, Radiopaedia.org, rID: 192003)
Figure 2: Petechial patches on body
(Image sourced from DermNet)
