Purpura fulminans is a rare complication of septic shock, often associated with Streptococcus pneumoniae. Patients with anatomic or functional asplenia are at increased risk for infection because of impairment of their ability to defend against encapsulated pathogens. We report the case of a previously healthy, unimmunized 33-year-old female with functional asplenia who presented in septic shock and purpura fulminans and died in spite of maximal resuscitative measures. The clinical presentation, diagnosis, and management of purpura fulminans are reviewed. Purpura fulminans is a rare condition that requires early diagnosis and aggressive management by emergency physicians.
RÉ SUMÉLe purpura fulminant est une complication rare du choc septique, souvent associé à une infection à Streptococcus pneumoniae. Les personnes atteintes d'asplé nie anatomique ou fonctionnelle sont pré disposé es aux infections en raison de l'incapacité de l'organisme de se dé fendre contre les agents encapsulé s. Il sera ici question du cas d'une femme de 33 ans, non vacciné e, auparavant en bonne santé , mais souffrant d'asplé nie fonctionnelle, qui est arrivé e en é tat de choc septique, accompagné de purpura fulminant, et qui est morte malgré toutes les mesures possibles de ré animation. Nous passerons en revue le tableau clinique du purpura fulminant ainsi que le diagnostic et la prise en charge de la maladie; il s'agit d'une affection qui appelle un diagnostic pré coce et une prise en charge é nergique par les urgentologues.
Highlights
Tumour lysis syndrome is an oncologic emergency.
Tumour lysis syndrome is most commonly encountered in hematologic malignancies.
Herein we report a case of tumour lysis syndrome in an endometrial stromal sarcoma.
Pulmonary function capacity contributes substantially to the capacity to exercise. Standard measures of flows and volumes are dependent on the strength of the respiratory muscles. We hypothesize that the strength of the respiratory muscles is an independent contributor to the common measurements of pulmonary function and maximum ventilation achieved during exercise testing. Methods: 39,859 subjects had measurements of MIP, MEP, VC, FEV1, PEFR, VA, MBC, Maximum Power Output and the maximum ventilation achieved following cardiopulmonary exercise testing. The contribution of MIP and MEP to all these factors were explored using simple linear regression analysis. Results: With the lone exception of the FEV1/VC ratio, all pulmonary function measurements are, in part, a function of the strength of the respiratory muscles. (table of correlation coefficients). Conclusions: Respiratory muscle strength is a hidden and often overlooked contributor to the capacity to exercise through its contribution to the capacity to breathe.
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