A 26-year-old sickle cell disease patient presented to the accident and emergency department with 1-day history of headache, vomiting, and confusion. Cardiopulmonary resuscitation was initiated for unobtainable BP. He was then shifted to the ICU.
A physical examination revealed a cyanotic face with mottled and cool extremities. Confluent satellite cutaneous purpura was present on the hands and feet. Temperature was 38.8°C, heart rate was 140 beats/min, and arterial pressure was 90/45 mm Hg while the patient received high doses of norepinephrine. However, the large arterial pulses of the involved extremities were all normal (Fig 1