Purpura Fulminans Secondary to Rickettsial Infection: A Case Report

Biradar, S. M.; Holyachi, Renuka; Kadeli, Deepak

doi:10.7860/jcdr/2015/12719.6701

Cited by 3 publications

(4 citation statements)

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“…Purpura fulminans first described by Guelliot in 1884, is a heterogeneous group of disorders characterized by rapidly progressive purpuric lesions that develop into extensive areas of skin necrosis, and peripheral gangrene. 2,4 Three forms of purpura fulminans include acute infectious, neonatal and idiopathic purpura fulminans. 4 The most common form is acute infectious purpura fulminans.…”

Section: Discussionmentioning

confidence: 99%

“…4 Rickettsial infections have been rarely associated with purpura fulminans. 2 Pathogenesis involves activation of complement and coagulation pathways by endotoxins and signaling by inflammatory cytokines or endothelial dysfunction and vasculitis caused by the antigen. 2 Consequently there is acute transient decrease in protein C, protein S or antithrombin III levels.…”

Section: Discussionmentioning

confidence: 99%

“…2 Pathogenesis involves activation of complement and coagulation pathways by endotoxins and signaling by inflammatory cytokines or endothelial dysfunction and vasculitis caused by the antigen. 2 Consequently there is acute transient decrease in protein C, protein S or antithrombin III levels. 4 Complications of purpura fulminans include disseminated intravascular coagulation, end-organ damage, septicemic shock and necrotizing fasciitis.…”

Section: Discussionmentioning

confidence: 99%

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Purpura fulminans secondary to indian tick typhus: a case report

et al. 2021

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Purpura fulminans is a rare and commonly fatal syndrome that consists of hemorrhagic infarction of the skin and intravascular thrombosis. Purpura fulminans is commonly associated with streptococcal, staphylococcal and meningococcal infection. Indian tick typhus is a rare cause of purpura fulminans. One of the rare causes of purpura fulminans is Indian tick typhus, which is a type of rickettsial spotted fever caused by Rickettsia conorii and transmitted to humans by Rhipicephalus sanguineus (also called the dog tick). Clinical features of Indian tick typhus include fever, maculopapular rash that begins on the extremities with a centripetal spread, and constitutional symptoms including headache, malaise and conjunctival congestion. Severe cases can progress to multi-organ disease including pulmonary edema, meningoencephalitis, renal failure and cardiogenic shock can occur. Current report present a case of a 48 year old male patient who presented with features of Indian tick typhus which progressed to purpura fulminans and necrotizing fasciitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Purpura fulminans secondary to indian tick typhus: a case report

et al. 2021

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“…Biradar et al reported a case of a 60-year-old man who presented with purpuric lesions over both upper and lower limbs and consumption coagulopathy following rickettsial infection. He was treated with replacement of platelets and coagulation factors along with antibiotics and doxycycline, and he made an uneventful recovery [ 15 ]. Katoch et al described a case series of purpura fulminans that included four pediatric patients treated with doxycycline with good recovery [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Rare presentation of rickettsial infection as purpura fulminans: a case report

Dalugama¹,

Gawarammana²

2018

J Med Case Reports

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BackgroundPurpura fulminans is an acute life-threatening disorder characterized by intravascular thrombosis and hemorrhagic infarction of the skin complicated with disseminated intravascular coagulation. It is commonly seen in acute infections following meningococcal and streptococcal infections. Few cases of purpura fulminans following rickettsial infections have been described in the literature.Case presentationWe report a case of a 55-year-old Sri Lankan woman who presented to Teaching Hospital Peradeniya with a febrile illness, headache, and myalgia that progressed to an erythematous rash starting over the bilateral lover limbs and hands and that became black and necrotic with a few hemorrhagic blebs. She had normocytic anemia, platelet clumps, and monocytosis as well as a deranged clotting profile. The result of immunofluorescence antibody testing for rickettsial immunoglobulin G was strongly positive for Rickettsia conorii with a rise in titer convalescent sera, and a diagnosis of purpura fulminans following rickettsial infection was made. The patient made an excellent recovery with chloramphenicol treatment.ConclusionsThe treating physician should consider the rare but very treatable condition of rickettsial infection as a differential diagnosis in the etiological diagnostic workup of patients presenting with severe purpuric and hemorrhagic rash with fever.

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Early fasciotomies and plastic-surgical reconstruction may enhance preservation of functional extremity length in purpura fulminans

Koch

Taeger

Geis

et al. 2020

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BACKGROUND: Purpura fulminans (PF) is a distinct form of rare meningococcal septicaemia mostly in childhood which is characterized by high lethality, extensive necroses and mutilations of extremities. Other ethiologies are idiopathic forms or purpura neonatorum, which is marked by deficiency of Protein-C. PF is caused by micro-embolism of the vascular system, followed by quickly spreading necroses of skin and different organs. Modern concepts of intensive care treatment of the acute phase of this disease and early surgical intervention lead to a rising number of surviving patients requiring limb salvage. Aim of this study is to evaluate a possible lower morbidity and the grade of lower loss of function because of early surgical intervention. PATIENTS AND METHODS: Between the years 1998 and 2017 eight cases of PF at two large centers for critical wound care, the department of plastic-, hand- and reconstructive surgery of the university hospital of Regensburg and the department of plastic-, hand- and reconstructive surgery of the BG-clinic Ludwigshafen were included into our study. We retrospectively examined patients with PF who were stabilized by intensive care medicine and received surgical interventions. After survival of the acute phase (10 days), patients received plastic surgical reconstructions. RESULTS: A total number of eight patients could be included into our study. All patients survived the initial phase (10 days). All patients required plastic-surgical interventions to address extensive skin and soft tissue defects. Flap operations were judged necessary in five cases. Hereby four defects could be reconstructed by free tissue transfer, one with a local flap. Flap survival was 100 percent. One flap required revision of the arterial anastomosis of the flap arteria. Another flap got partial necrosis. One patient died due to multiorgan failure. Early debridements with consequent fasciotomies and secondary plastic-surgical reconstruction achieved good functional results. Limb salvage was accomplished in three patients. One patient died due to fulminant progress of the disease. CONCLUSION: Management of PF requires a multidisciplinary approach and close communication between the different subspecialties. Early debridements with consequent fasciotomies showed good results in salvaging subfascial muscle tissue in the extremities with satisfying functional results. Early surgical intervention is an important factor for improved limb salvage and survival.

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Purpura Fulminans Secondary to Rickettsial Infection: A Case Report

Cited by 3 publications

References 9 publications

Purpura fulminans secondary to indian tick typhus: a case report

Purpura fulminans secondary to indian tick typhus: a case report

Rare presentation of rickettsial infection as purpura fulminans: a case report

Early fasciotomies and plastic-surgical reconstruction may enhance preservation of functional extremity length in purpura fulminans

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