At this stage, the blood picture showed fragmented red cells and thrombocytopenia suggesting early DIC. Her hemoglobin dropped to 8.6 g/dL from 10 g/dL and the platelet count was 76 × 103/mL, APTT 40 s with INR 1.3 and elevated D dimers of 1.2 ng/ml (normal < 0.5 ng/ml). However, she did not have active bleeding from elsewhere. The clinical picture together with the rash led to the clinical suspicion of infective endocarditis, meningococcal or gonococcal septicaemia, severe staphylococcal or streptococcal sepsis, acute flare of connective tissue disease with vasculitis, cryoglobulinemia, a hemorrhagic form of leptospirosis, or rickettsial infection.