A 31-year-old woman presented with fever, chills, and abdominal pain for 1 day. On examination, she was found to have a temperature of 35.3 deg C, pulse rate of 109 beats per minute, and blood pressure of 123/95 mm Hg. Generalized petechiae were noted over the trunk and extremities. The abdomen was soft without rebound tenderness. Pertinent laboratory data were as follows: blood urea nitrogen 14 mg per 100 ml, creatinine 2.1 mg per 100 ml, sodium 134.2 mEq l~(-1), potassium 2.54 mEq 1~(-1), aspartate aminotransferase 49 IU l~(-1), alanine aminotransferase 3IU l~(-1), and total bilirubin 0.75 mg per 100 ml. The patient had aprofound metabolic acidosis with pH of 7.190, bicarbonate of 13 mmol l~(-1), and lactate of 9.7 mmol l~(-1). White blood cell count was 7900 mul~(-1) (with 20 band form), hemoglobin 15 g mul~(-1), and platelet count was 18 000 mul~(-1). There was a marked coagulopathy with prothrombin time >80s and activated partial thromboplastin time > 200 s, fibrinogen level of 92.1 mg per 100 ml(normal 200-400), fibrin degradation product levels of 532.9 mug ml~(-1) (normally <5), and D-Dimer level of 85131.6 ng FEU ml~(-1) (normally <500). Abdominal computed tomography (CT) was performed to look for a focus of infection.
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