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Fulminant purpuric rash.

G Famularo1, C Pozzessere, V Trinchieri

  • 1Department of Emergency Medicine, San Camillo Hospital, Circonvallazione Gianicolense, Rome, Italy.

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
|January 5, 2002
PubMed
Summary
This summary is machine-generated.

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Purpura fulminans can rapidly develop in severe meningococcaemia despite early treatment. Acquired protein C deficiency is key, necessitating aggressive resuscitation and cautious management for meningococcal septic shock.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Critical Care Medicine

Background:

  • Meningococcaemia, a severe bacterial infection, can lead to purpura fulminans.
  • Purpura fulminans is a rare but life-threatening complication characterized by disseminated intravascular coagulation and skin necrosis.

Observation:

  • A fatal case of purpura fulminans due to meningococcaemia is presented.
  • Despite prompt and aggressive treatment, including hemodynamic support, purpura fulminans progressed rapidly.

Findings:

  • Necropsy revealed dermal microvascular thrombosis, consistent with meningococcal septic shock and skin-limited purpura fulminans.
  • Acquired deficiency of protein C, crucial for anticoagulant and anti-inflammatory functions, was identified as the central mechanism.

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Implications:

  • Purpura fulminans in meningococcaemia indicates a poor prognosis.
  • Early, aggressive resuscitation in the emergency department is recommended, including antibiotics, volume expansion, inotropes, and protein C replacement.
  • A skeptical approach to patient management is advised, even with initial resuscitation success.