Purpura fulminans

Background

  • Life-threatening syndrome of intravascular coagulation and hemmorrhagic skin infarction→ DIC and vascular collapse
  • Usually occurs in children, but can occur in adults
  • Most commonly in the setting of overwhelming sepsis OR 7-10 days after infection

Causes

  • Meningococcus
  • Streptococcus species
  • Varicella
  • Rickettsia sp
  • Venom-induced consumptive coagulopathy (VICC) due to snake bites
  • Protein C, protein S, or antithrombin III deficiency
  • Drug-induced

Clinical Features

Differential Diagnosis

Petechiae/Purpura (by findings)

Evaluation

  • DIC work up
    • CBC, PT/PTT, fibrinogen, d-dimer, FDP
  • Infectious work up

Management

  • Treat shock
  • Treat underlying infection
  • Necrotic tissue may require debridement
  • Coagulopathy correction, in some cases
    • Typically only if bleeding or need for procedure
      • Exception: FFP usually indicated for neonatal purpura fulminans
    • Cryoprecipitate: consider if fibrinogen <100
    • Platelets: consider repletion if <50K with bleeding or <20K without bleeding
    • FFP: consider repletion to goal of PT and PTT < 1.5 times the normal limit
    • Vitamin K, folate

Disposition

  • Admit!

See Also

  • Coagulopathy (Main)
  • DIC

References

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