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Purpura Fulminans and Spotted Fever: A Case Series from South India

Karthik Gunasekaran1, Divyaa Elangovan2, Susmitha Perumalla2

  • 1Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India.

Journal of Global Infectious Diseases
|January 13, 2023
PubMed

Insights

Purpura fulminans (PF) in India is rarely linked to rickettsial infections. This case series shows early diagnosis and treatment of spotted fever can lead to favorable outcomes, even with severe symptoms like gangrene.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Dermatology

Background:

  • Purpura fulminans (PF) is a rare, severe thrombotic disorder often associated with infections.
  • Rickettsial infections, particularly spotted fevers, are increasingly recognized globally but underreported in India concerning PF.
  • Early recognition and management are crucial for favorable outcomes in severe infectious diseases.

Observation:

  • This case series describes seven adult patients in India presenting with Purpura fulminans.
  • Four patients were diagnosed with definitive spotted fever via ompA real-time PCR.
  • Three patients had probable spotted fever, confirmed by IgM ELISA and rapid clinical response to antibiotics.

Findings:

  • Three out of seven patients developed peripheral gangrene, a severe complication of Purpura fulminans.
  • All seven patients with Purpura fulminans associated with spotted fever experienced a favorable outcome.
  • Early initiation of rickettsia-specific therapy, supported by diagnostic assays, was key to recovery.

Implications:

  • Highlights the importance of considering rickettsial infections in Purpura fulminans cases in India.
  • Emphasizes the efficacy of prompt diagnosis and targeted antibiotic treatment for severe spotted fever.
  • Suggests that a high index of suspicion and rapid diagnostic support can improve prognosis in Purpura fulminans.
Keywords:
Febrile rashgangrenepurpura fulminansrickettsiaspotted fever

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