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Purpura fulminans during meningococcal sepsis treated with Drotrecogin alpha. A clinical case
G Belloni1, P Ramello, M R Salcuni
1Anesthesia and Intensive Care Unit, City Hospital, Ivrea, Italy. rianimazione@asl.ivrea.to.it
Abstract:
A male patient, 29 years old, was admitted to our unit with purpura fulminans, coagulation deficiency, renal failure and subsequent septic shock accompanied by respiratory insufficiency in the absence of meningeal signs. The serum levels of endogenous protein C, ATIII and calcium were well below the norm. The bacteriological examination revealed the presence of gram-negative diplococci. The onset of adult respiratory distress syndrome (ARDS) revealed aa early complication of the meningococcal sepsis. Forty-eight hours after being admitted, the recombinant protein C infusion was started at a dose of 24 microg/kg/h for the duration of 96 h. The skin lesions regressed, starting from the ecchymosis and the edema of the face, trunk and auricular pavilions. A week after the onset of the symptomatology the chest X-ray appeared clear, the renal function had normalised, and the signs of shock had disappeared.
Insights
This case study highlights a severe meningococcal sepsis case in a 29-year-old male. Recombinant protein C infusion effectively treated purpura fulminans, coagulation deficiency, and organ failure.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hematology
Background:
- Meningococcal sepsis can lead to severe complications like purpura fulminans and disseminated intravascular coagulation.
- Coagulation deficiencies, including low protein C and ATIII levels, are critical indicators in severe sepsis.
- Adult respiratory distress syndrome (ARDS) is a recognized early complication of meningococcal sepsis.
Observation:
- A 29-year-old male presented with purpura fulminans, coagulation deficiency, renal failure, septic shock, and respiratory insufficiency.
- Laboratory findings revealed significantly low serum levels of endogenous protein C, ATIII, and calcium.
- Bacteriological examination confirmed the presence of gram-negative diplococci, indicative of meningococcal infection.
Findings:
- Recombinant protein C infusion (24 microg/kg/h for 96 h) was initiated 48 hours after admission.
- The treatment led to the regression of skin lesions, including purpura and edema.
- Within a week, the patient showed radiological improvement in chest X-ray, normalized renal function, and resolution of shock.
Implications:
- Recombinant protein C therapy is a viable treatment for severe meningococcal sepsis with purpura fulminans and coagulation deficiency.
- Early recognition and intervention with protein C concentrate can mitigate life-threatening complications.
- This case underscores the importance of managing coagulation abnormalities in sepsis to improve patient outcomes.
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