A 61-year-old female is brought to an urgent care clinic by her husband with altered mental status for 1 day. She was doing well until yesterday when she started to feel excessively drowsy. She had a renal transplant 18 months back. She is compliant with her immunosuppressive medications. On physical examination, her temperature is 39.4°C (103.0°F), blood pressure is 85/50 mm Hg, pulse 135/min and respirations are 24/min. Her Glasgow Coma Score is 10/15. There are few black skin lesions on the trunk with a necrotic center forming an eschar. Her laboratory investigation reveals the following:
A 30-year-old woman comes to the clinic complaining of shaking chills, fever and headache for the last 3 days. She says that she recently returned from a trip to India where she was visiting family. There is no history of loss of consciousness or respiratory distress. Vitals noted are temperature of 38.9℃ (102.0℉), respiratory rate of 19/min, blood pressure of 120/80 mm Hg, rapid and thready pulse 94/min could be palpated. On general examination she looks pale and there is presence of jaundice in her upper sclerae. Laboratory findings are as follows:
|Total bilirubin||2.6 mg/dL|
|Direct bilirubin||0.3 mg/dL|
Peripheral smear is shown in the exhibit. What is the most deadly complication of this condition?