Case Number : Case 4044 - 21 July 2022 Posted By: Saleem Taibjee

Large ecchymosis with hemorrhagic necrosis of the skin is seen clinically. Biopsy shows thrombotic vasculopathy without vasculitis, features suggestive of purpura fulminans. Extremely grave prognosis is the rule. Patient must be investigated for acquired protein C or protein S deficiency as a result of some antecedent infection.

looks like thrombotic vasculopathy, fibrinoid necrosis of vessels.. would think of cryoglobulinemia..

thrombotic vasculopathy needs further investigations

Thrombotic vasculopathy for work up..

DIC is a good spot. 

Will also consider doing calcium stain for calciphylaxis

This is a case of warfarin necrosis.

Of course, this needs clinical correlation. But the pathologist may need to specifically query whether the patient is taking warfarin and therefore raise this possibility. As is often the case, the warfarin had been temporarily stopped and then recently re-started. This leads to an imbalance of pro-thrombotic versus anti-coagulant factors and the 'paradoxical' thrombotic picture rather akin to DIC.

BW

Saleem

please see for protein c or s levels