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CLINICAL IMAGE
Year : 2015  |  Volume : 141  |  Issue : 1  |  Page : 130-131

Infectious purpura fulminans


Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India

Date of Web Publication2-Apr-2015

Correspondence Address:
Alladi Mohan
Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.154523

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How to cite this article:
Harikrishna J, Mohan A. Infectious purpura fulminans. Indian J Med Res 2015;141:130-1

How to cite this URL:
Harikrishna J, Mohan A. Infectious purpura fulminans. Indian J Med Res [serial online] 2015 [cited 2019 Aug 20];141:130-1. Available from: http://www.ijmr.org.in/text.asp?2015/141/1/130/154523

A 60 year old male patient was admitted to the

medical intensive care unit (MICU) at the Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, in October 2013, with acute exacerbation of chronic obstructive pulmonary disease, acute respiratory failure requiring mechanical ventilatory support. While on treatment he developed new onset fever and evidence of septic shock. Pseudomonas bacteraemia was evident on blood culture. Laboratory work-up revealed a low platelet count (25,000/µl); prolonged prothrombin time (test = 18.4 sec, control = 13.2 sec) and activated partial thromboplastin time (test = 38 sec, control = 32 sec); decreased serum fibrinogen level (80 mg/dl) which was suggestive of overt disseminated intravascular coagulation (DIC) with a score of 5 as per the International Society for Thrombosis and Haemostasis (ISTH) Diagnostic Scoring System [1],[2] . The patient developed characteristic skin lesions over the right lower limb ([Figure 1]) and succumbed to his illness within 48 hours of onset of these lesions.
Figure 1. photograph showing non-blanchable, purple coloured skin lesions with well defined margins (arrow heads) along with bullae (arrows) containing clear fluid suggestive of infectious purpura fulminans.

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Purpura fulminans is an acute, often lethal syndrome characterized by DIC. It starts as well-demarcated erythematous macules that progress rapidly with haemorrhagic necrosis resulting in dark raised lesions, with vesicle or bulla formation [3] . It has been observed in severe acute bacterial infections caused by  Neisseria More Details meningitidis, Streptococcus pneumoniae, Group A and B streptococci, Staphylococcus aureus, Haemophilus influenzae, Plasmodium falciparum malaria and heritable protein C pathway defects [4] . Pseudomonas bacteraemia is an uncommon cause of purpura fulminans. It is important to recognize this uncommon cutaneous manifestation of systemic sepsis early and institute appropriate aggressive management as it is associated with a high mortality.

 
   References Top

1.
Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol 2009; 145 : 24-33.  Back to cited text no. 1
    
2.
Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86 : 1327-30.  Back to cited text no. 2
    
3.
Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3 rd . Modern concepts of the diagnosis and treatment of purpura fulminans. J Environ Pathol Toxicol Oncol 2008; 27 : 191-6.   Back to cited text no. 3
    
4.
Chalmers E, Cooper P, Forman K, Grimley C, Khair K, Minford A, et al. Purpura fulminans: recognition, diagnosis and management. Arch Dis Child 2011; 96 : 1066-71.  Back to cited text no. 4
    


    Figures

  [Figure 1]


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