BMJ Case Reports 2013; doi:10.1136/bcr-2012-006519
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Symmetrical peripheral gangrene and disseminated intravascular coagulation associated with pelvi-ureteric junction obstruction

  1. James McLay
  1. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Victoria Louise Reid, victoria.reid{at}


An 87-year-old woman presented to the emergency department with confusion, sinus tachycardia, hypotension and fever. Laboratory investigations confirmed metabolic acidosis, acute kidney injury (urea 18.5 mmol/l, serum creatinine 197 µmol/l and Egfr 21 ml/min/1.73 m2), depressed bone marrow function (platelets 136×109/l and white cell count (WCC) 3.0×109/l) and elevated prothrombin and activated partial thromboplastin time (PT 15.8 s and APTT 61 s). Urinalysis was positive for blood, protein and leucocytes. Severe sepsis was diagnosed …

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