Sudden hematemesis with death

Author: Ma Theresa Alianza

Question
8828-C San Mateo St., San Antonio Valley 2, Paranaque City Philippines.

A 17 years old girl presented with headache for 5 days and epigastric pain, fever, hematemesis {1 cup full} and erythematous rash over all 4 limbs for 1 day prior to admission. Three hours prior to admission she had increased headache, epigastric pain with violaceous rash on thighs and increased menstrual flow with difficulty in breathing. There were no cough, colds, diarrhea, dysuria, or increase in sleeping time. She was suspected to have hemolytic uremic syndrome or blood dyscrasias. On examination her systolic blood pressure was 80 mm of Hg, heart rate was 135, min {pulses were not felt}, CRT was 5-6 sec and respiratory rate was 40, min. She had cold clammy skin with ecchymotic rash over lower extremities, pale conjunctivae, sallow sclerae, pale lips, and dry buccal mucosa. On systemic examination she had epigastric tenderness. Other systems were normal. She was non-responsive to fluid resuscitation {PLRS 500ml x 3 doses}. She died before inotropes could be started. Her investigations showed anemia, leukocytosis {WBC 41,400, cumm} with predominance of polymorphs {75 percent}. She had deranged Prothrombin time { More than 60sec} and Partial thromboplastin time { More than 60sec}. She had hypoglycemia {Blood sugar = 32.36mg, dL}, hyponatremia {Serum sodium = 131mmol, L}, hyperkalemia {serum potassium = 5.3mmol, L}, hypocalcemia {Serum calcium = 7.08mg, dL} with raised blood urea nitrogen {20.17mg, dL}, increased serum creatinine {2.36mg, dL} with BUN: creatinine ratio=8.5 suggestive of intrinsic renal failure. Her urine showed trace sugar, 3plus proteins, with presence of urine hemoglobin.

What is the diagnosis_?

Answer Discussion :

zohdi alhanouty