An elderly woman developed acrocyanosis, pain and numbness in her fingers several days after sustaining a scratch on her left index finger by a turtle. She also had malaise, weakness, nausea, vomiting and diarrhea. She lived in a rural area of the Southwest US and owned several dogs. On exam, she was febrile and hypotensive. Skin findings are shown. Six of six blood culture bottles grew gram negative rods.
The most likely diagnosis is which of the following?
What is the diagnosis?
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