A 19-year-old female college student presents with a 2-day history of fever (39.2°C), petechial rash on her lower extremities and trunk, and progressive confusion. Vital signs: HR 112/min, BP 98/62 mmHg, RR 22/min, SpO2 98% on room air. Lumbar puncture reveals CSF with protein 180 mg/dL, glucose 18 mg/dL (serum glucose 95 mg/dL), and 450 WBC/μL (85% neutrophils). Blood cultures are pending. A skin biopsy from an involved petechial lesion is obtained. Histologic examination shows fibrinoid necrosis of small dermal vessels with dense neutrophilic infiltration, leukocytoclasis, and disruption of the vessel wall architecture. Which of the following best describes the pattern of vascular injury seen in this patient?
- A)Medial hyaline sclerosis with smooth muscle cell degeneration
- B)Chronic granulomatous inflammation with giant cell formation
- C)Intimal proliferation and fibrosis without acute inflammation
- D)Acute necrotizing vasculitis with fibrinoid necrosis and leukocytoclasisGABARITO
- E)Atherosclerotic plaque with lipid core and fibrous cap
Explicação
This patient presents with meningococcemia with meningitis, evidenced by fever, petechial rash, meningeal signs, and CSF pleocytosis with low glucose and elevated protein. The skin biopsy shows the classic histologic hallmark of acute necrotizing vasculitis: f... Ver explicação completa e trilha adaptativa →