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1296 PART 11: Special Problems in Critical Care

FIGURE 129-23. Vascular occlusion syndrome due to cryoglobulinemia. A. Livedo reticularis on the lower extremities. B. Retiform purpura. (Used with permission of Dr Aisha Sethi.)

surrounding skin is edematous. The blister fluid is sterile, usually clear can spread superficially or invade to the deeper subcutaneous tissue,
but it can be serous or bloody as well. The bullae resolve rapidly with depending on host and virulence factors. Secondary infections occur by
improvement of the edema. Diuretics, compression bandages, and eleva- hematogenous dissemination of the organism or portions of the organ-
tion of the extremity expedite the resolution of edema bullae. ism and may be accompanied by immune complex deposition.
DERMATOSES PRECIPITATED BY INFECTION ■ NECROTIZING FASCIITIS
■ BACTERIAL INFECTIONS Necrotizing fasciitis (NF) is a rapidly progressive suppurative bacterial
infection of the superficial and deep fascia that, if left unchecked, pro-
Infectious organisms can involve the skin via a primary or secondary gresses to gangrene, sepsis, and death. The pathogenesis, presentation,
route. Primary infections begin as a localized exogenous invasion that

FIGURE 129-24. Purpura fulminans with peripheral gangrene. (Used with permission FIGURE 129-25. Edema bullae. Clear fluid-filled, intact bullae, surrounded by edema-
of Dr Joaquin Brieva.) tous skin, on the extensor forearm. (Used with permission of Dr Aisha Sethi.)

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