Clinico-Etiological Study of Purpura Fulminans: Experience from a Tertiary-Care Children Hospital

Purpura fulminans (PF) is a potentially fatal disease characterized by rapidly progressive purpura that evolves into cutaneous necrosis and gangrene.

This was an observational, retrospective study based on the review of case records of children with PF at a tertiary care children's hospital in Karnataka.

Twenty-two cases seen over a period of four years were included. The age of the study population ranged from 11 days to 13 years (mean age: 4.21 years) and a male to female ratio of 1:1.2. Fever with purpura (86.3%) was the most common presenting symptom followed by swelling of the face and limbs (27.2%), altered sensorium (27.2%), convulsions (22.7%), abdominal distension (4.5%), respiratory distress (4.5%), myalgia (4.5%), and jaundice (4.5%). Cutaneous features included reticulate purpura (100%), necrosis (45.4%), ulcers (18.2%), maculopapular lesions (9.1%), and bullae (9.1%). Peripheral gangrene developed in eight children ( 36.3%). Lower limbs (90.9%) and upper limbs (86.3%) were the most common sites of involvement. The common causes were rickettsial fever (63.6%), Moraxella (4.5%), Leptospira (4.5%), multisystem inflammatory syndrome in children (4.5%), co-infections with Klebsiell a and Acinetobacte r (4.5%), Klebsiell a and Citrobacte r (4.5%), rickettsial fever with multisystem inflammatory syndrome (4.5%) and protein C deficiency (4.5%). The mortality rate was 4.5%.

The retrospective nature of the study and the single-institution cohort were the limitations of this study.

Rickettsial infection was the most common etiology, while reticulate purpura, necrosis, and ulcers were the commonly seen cutaneous features of PF.