Purpura Fulminans in a Patient with Rheumatoid Arthritis

Abstract

© 2009 The Authors. doi: 10.2340/00015555-0733 Journal Compilation © 2009 Acta Dermato-Venereologica. ISSN 0001-5555 Sir, Purpura fulminans (PF) is a rare disorder characterized by thrombosis of dermal vessels and skin necrosis with or without consumptive coagulopathy (1). PF is usually classified into three types: haemostasis-initiated PF or neonatal PF; acute infectious PF; and idiopathic PF (2). However, accumulated evidence has shown that there may be another type of PF: drug-induced PF (3–5). Disseminated intravascular coagulation (DIC) exists in most, but not all, cases of PF. Some cases have only cutaneous manifestations but mild coagulation changes. The management of PF is difficult and varies with the clinical types of PF. Intravenous heparin inhibits intravascular clotting and reduces consumption of anticoagulant factors. The role of systemic corticosteroid therapy is controversial. We report here a case of drug-induced PF in a patient with rheumatoid arthritis (RA) who administered a pain-relieving traditional Chinese medication (TCM) called Anluotong Pian.