Snapshot A 46-year-old woman presents to the emergency room for a headache that worsens with flexion of the neck. She is started on broad-spectrum antibiotics and prepped for a lumbar puncture. However, laboratory evaluation reveals marked thrombocytopenia and elevated D-dimer. On physical exam, she is noted to have retiform purpura over the toes bilaterally, as well as dusky nasal tip. After platelet transfusion, a lumbar puncture is performed. (Meningitis-induced disseminated intravascular coagulation) Introduction Overview login to view 1 more bullet Epidemiology Incidence login to view 1 more bullet Risk factors login to view 8 more bullets ETIOLOGY Pathogenesis login to view 6 more bullets Presentation Physical exam login to view 9 more bullets Studies Serum labs login to view 8 more bullets Peripheral blood smear with microangiopathic changes login to view 1 more bullet Differential Heparin-induced thrombocytopenia login to view 2 more bullets DIAGNOSIS Diagnosis is based on clinical and laboratory findings, including thrombocytopenia, coagulation factor consumption, and fibrinolysis Treatment Medical login to view 10 more bullets Complications Renal failure Liver injury Neurologic symptoms login to view 1 more bullet Waterhouse-Friderichsen syndrome login to view 2 more bullets Purpura fulminans login to view 2 more bullets