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Purpura on the truncus and extremities
  1. Ryutaro Tanizaki1,
  2. Masaki Oya2,
  3. Yousuke Takemura3
  1. 1Department of Community Medicine, IGA, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
  2. 2General Medicine, Nabari City Hospital, Nabari-city, Mie, Japan
  3. 3Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, Tsu-city, Mie, Japan
  1. Correspondence to Dr Ryutaro Tanizaki, General Medicine, Nabari City Hospital, West 1st-178, Yurigaoka, Nabari-city, Mie 518-0481, Japan; rtanizak20{at}

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Clinical introduction

A 36-year-old woman with Down's syndrome and spleen hypoplasia presented with a fever of 40°C lasting for 12 h. She had taken 1 mg prednisolone/day for mild graft-versus-host disease after allogeneic stem cell transplantation 4 years previously. Her BP was 91/44 mm Hg, HR 110 beats/min and RR 30 breaths/min. Her heart sound, lung sound and skin appearance were unremarkable. Laboratory findings showed leucocytosis (13.12×109/L) and normal platelet count (269×109/L). She was discharged home, but 16 h after fever onset, experienced cardiopulmonary arrest.


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