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A 51-year-old woman was transferred to the emergency department with fever, malaise and abdominal pain, all of which had started 12 hours earlier. Her medical history was unremarkable.
On arrival, she was alert, febrile (38.3°C) and hypotensive (87/55 mm Hg). She had several petechiae on her face. Examination of the abdomen revealed mild diffuse tenderness without rebound. There was no meningismus. Blood tests showed leucocytosis (11.6×109/L), thrombocytopenia (4×109/L) and coagulation disturbances (INR 3.66, PTT 125.84 s, fibrinogen 0.6 g/L, D dimers 33 964 mg/L). An image of the peripheral-blood film is shown in figure 1.
Contributors All authors were involved in the diagnosis and care of the patient. All authors have contributed to the writing of the manuscript. All authors agree to the submission of this article to the Emergency Medicine Journal.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Next of kin consent obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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