Spectrum of purpura fulminans: Report of three classical prototypes and review of management strategies

Abstract

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and is accompanied by vascular collapse and disseminated intravascular coagulation. It usually occurs in children, but this syndrome has also been noted in adults. The three forms of this disease are classified by the triggering mechanisms. We describe three classical cases of purpura fulminans of the three classical prototypes treated at our center and their varied clinical outcomes. We also describe a case of acute infectious purpura fulminans secondary to systemic leptospirosis which to our best knowledge is the first reported case in world literature. The various treatment options for purpura fulminans have also been reviewed.

Sepsis-induced purpura fulminans caused byPasteurella multocida

“…We found in the literature one isolated case of purpura fulminans secondary to systemic leptospirosis and two cases of purpura fulminans caused by Capnocytophaga canimorsus , after a dog bite 7 10 11…”

“…In extreme cases, this necrosis may lead to symmetrical peripheral gangrene 4 7 8. This process also affects the lungs, kidneys and adrenal glands, leading to multiorganic failure 4 9…”

Pneumococcal Sepsis–induced Purpura Fulminans in an Asplenic Adult Patient Without Disseminated Intravascular Coagulation

“…2,6 Classically, acute infectious PF cultivates in the setting of gram-negative sepsis and endotoxemia resulting in hemostasis disruption. 2,6 Classically, acute infectious PF cultivates in the setting of gram-negative sepsis and endotoxemia resulting in hemostasis disruption.…”

“…5 It is unclear whether vaccination averts the likelihood of severe complications of pneumococcal sepsis in splenectomized individuals. [2][3][4][6][7][8][9][10][11][12] [2][3][4][6][7][8][9][10][11][12] …”

Purpura Fulminans Managed with Multi-Limb Amputation: Substituted Judgment and Surrogate Decision-Making in the Surgical Management of Necrotizing Soft Tissue Infections

“…The treatment of adult PF includes initial aggressive resuscitation and early initiation of broad spectrum antibiotic therapy. Other therapies include fasciotomy for resultant compartment syndrome, plasma infusion and vasodilators, sympathetic blockade, and anti-platelet therapy [4][5][6][7].…”