A 62 year-old man complains of fever and diminished consciousness for 2 days


#1

A 62 year-old man complains of fever and diminished consciousness for 2 days. He has been healthy all his life and he doesn’t take any medications. On examination, he responds inconsistently to commands. His temperature is 103 F, pulse 110/min and blood pressure is 80/56 mmHg. His physical examination is otherwise normal. There is no bleeding. Laboratory test are as follows:

Hemoglobin: 12 g/dl

Leukocyte count: 25,000 – 80% neutrophils

Platelet count: 20,000

D-dimer is high

Fibrinogen level is low

What is the most likely diagnosis?

A – Idiopathic thrombocytopenic purpura

B – Thrombotic thrombocytopenic purpura

C – Disseminated intravascular coagulation

D – Hemophilia a

E – Hemophilia b

Answer

This patient most likely has sepsis leading to disseminated intravascular coagulation. It is confirmed by increased D-dimer and low level of fibrinogen. He has been healthy all his life so, acute infection leading to sepsis is the most likely etiology while major conditions that usually show up in younger age as purpura and hemophilia are not likely associated with this man’s condition.

The correct answer is C