[Febrile purpura in children]

The association of fever and purpura should first suggest the diagnosis of fulminant meningococcemia, owing to the severity of this condition. Compromise of peripheral circulation (cyanosis, prolonged refilling time) is important to consider, because normal blood pressure is usually observed at an early stage of a septic shock in children and particularly in young infants. When this hypothesis has been eliminated, other causes of febrile purpura can be considered: meningococcal meningitis; measles or other viral diseases; non infectious causes include mechanical purpura, Schönlein-Henoch's purpura and thrombocytopenia. In the frequent case where no cause has been found, the diagnosis of occult bacteriaemia should be considered, leading to parenteral administration of antibiotic following blood and cerebrospinal fluid cultures.