Systemic Inflammatory Response Syndrome
In this patient, there appears to be a confluence of three disease processes causing a systemic illness with manifestations involving the skin and central nervous system. At the time of presentation to the emergency department, the patient’s heart rate was higher than 90 beats per minute and her white-cell count was greater than 12,000 per cubic millimeter. With the presence of these two findings, she met the criteria for the systemic inflammatory response syndrome (SIRS).3 Although thrombocytopenia was present, there was no evidence of overt disseminated intravascular coagulation; the d-dimer level was only mildly elevated and the fibrinogen level, prothrombin time, and activated partial-thromboplastin time were normal.4 Hypokalemia, hypomagnesemia, hypophosphatemia, and hyponatremia and the presence of albumin, red cells, and renal tubular cells in the urine of this previously healthy patient also raise the possibility of sepsis.