A case of thrombotic microangiopathy/microangiopathies.

We report a case of Streptococcus pneumonia sepsis-associated disseminated intravascular coagulation (DIC) with features of acute renal failure and microvascular thrombosis characterized by skin purpura and bilateral foot necrosis. The persistence of laboratory features of microangiopathic hemolytic anemia despite aggressive correction of DIC-associated coagulopathy suggests the possibility of an additional concomitant microangiopathic process. Here, we discuss the management and diagnostic approach, particularly highlighting the difficulties in making a definitive diagnosis. Although unconfirmed, our differentials include the concomitant process of sepsis-induced DIC occurring together with an indeterminate form of plasmapheresis and plasma exchange-responsive thrombotic microangiopathy, processes which are previously believed to be mutually exclusive.