Acute Infectious Purpura Fulminans Research Articles

Acute Infectious Purpura Fulminans with Anticentromere Antibodies

Acute Infectious Purpura Fulminans with Anticentromere Antibodies

Acute infectious purpura fulminans: case report of a medical emergency

Abstract Background Purpura fulminans (PF), characterized by the sudden onset of large, rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation, is an uncommon medical emergency. Early recognition, prompt antibiotic therapy, and intensive supportive care are essential to reduce the mortality rate of this disease. Case Presentation We report the case of a 28-year-old Chinese man with acute infectious PF. He initially presented with a fever, which rapidly progressed to septic shock, followed by skin lesions and disseminated intravascular coagulation. Computed tomography imaging revealed superior and inferior mesenteric vein thromboses. Although the etiology of the patient’s infection was unclear, the patient received early fluid resuscitation, empiric antibiotic therapy, and blood product replacement, which resulted in gradual clinical improvement. Conclusion Sepsis-associated PF may be reversible with timely empirical therapeutic interventions; however, the severity of PF should not be underestimated, and treatment should be tailored to individual patients.

A Rare Case of Acute Infectious Purpura Fulminans Caused by Klebsiella Pneumoniae and Human Herpesvirus Type 5

BackgroundPurpura fulminans (PF), a rare, life-threatening disorder, is a hematological emergency in which there is skin necrosis, disseminated intravascular coagulation (DIC), and protein C deficiency. In PF, the skin necrosis and DIC are secondary to protein C deficiency. This may progress rapidly to multiorgan failure caused by the thrombotic occlusion of small- and medium-sized blood vessels.Case ReportThis article presents the case of a 22-year-old male with fever as well as necrotic and purpuric skin lesions. The ultrasound and computed tomography scans revealed infections in the skin wounds as well as venous microthrombosis and thrombosis in multiple intracranial and pulmonary vessels. The laboratory tests showed signs of sepsis, thrombocytopenia, an abnormal decrease in protein C and antithrombin III, DIC, multiple organ and system failures, gastric varices, and gastrointestinal hemorrhage. The blood, sputum, and secretions under the skin lesions were cultured and were positive for Klebsiella pneumoniae. The results of the high-throughput genetic testing of the pathogenic microorganism DNA were consistent. In addition, human herpesvirus type 5 was detected. The histopathological examination of the skin lesions revealed pathological features consistent with PF. After successful treatment by the departments of Dermatology, Emergency Critical Care Medicine, and the Intensive Care Unit, the patient was discharged after 67 days of hospitalization.ConclusionAdults with acquired protein C and/or S deficiency states, including certain bacterial and viral infections, who drink alcohol and take varieties of non-steroidal anti-inflammatory analgesics at the same time, may develop acute infectious PF. Clinicians should be aware of this for early diagnosis and treatment.

Acute Infectious Purpura Fulminans Complicated with Multiple Erosions

An 80-year-old man was extremely skinny and developed a left leg phlegmon. He was admitted and underwent an infusion of cefazolin. On the third day, he suddenly collapsed, and advanced cardiac life support resulted in a return of his circulation. He showed vasopressor-resistant hypotension and therefore received an infusion of steroids and multiple supportive therapies. A blood culture later showed Pseudomonas aeruginosa. While his blood pressure increased, he showed peripheral and labile cyanotic changes, even though his peripheral arteries were palpable. On the third day after the collapse, he showed blisters at purpura sites and labile, resulting in the formation of erosions. On the fourth day, massive effusion was drained from the erosive lesions. He temporarily showed a return of consciousness, but his extremities became necrotic, and he ultimately died due to a secondary infection at the erosive lesions. The present fatal case of acute infectious purpura fulminans might have been induced by a P. aeruginosa infection due to complications with multiple blisters, similar to Stevens-Johnson syndrome/toxic epidermal necrolysis. Early aggressive surgical amputation or debridement might be required to obtain a survival outcome when encountering such cases.

Acute infectious purpura fulminans: a case series from India.

Acute infectious purpura fulminans is a serious, potentially fatal condition. We present a case series of 11 patients from March 2005 to March 2017, whose clinical symptoms were fever (100%), confusion (63.6%) and headache (55%), and whose common laboratory abnormalities were thrombocytopenia (100%), elevated alkaline phosphatase (70%) and anaemia (63.6%). Three patients (27%) developed gangrene and two presented in shock. Only one grew Neisseria meningitidis in cerebrospinal fluid (CSF) culture and another confirmed by latex agglutination and polymerase chain reaction in CSF. Five others had serology confirmed spotted fever rickettsioses (SFG). All received broad spectrum antibiotics; in 9/11 patients, this included doxycycline or azithromycin. The mean hospital stay was 10.2 days and overall mortality was 18.2%.

A Case of Acute Infectious Purpura Fulminans following Laparoscopic Cholecystectomy

A Case of Acute Infectious Purpura Fulminans following Laparoscopic Cholecystectomy

潜在的脾機能低下が疑われたCapnocytophaga感染症の1例(A case of Capnocytophaga infections with suggestive of splenic dysfunction)

要旨Capnocytophaga canimorsusはイヌやネコの口腔内常在菌で，極めて稀であるが咬傷によりヒトに感染する。症例は58歳の女性。発熱と下痢，嘔吐を主訴に近医を受診し白血球数の著明な低下を指摘され，感染源不明の敗血症疑いとしてメロペネムの投与が開始されたが，その後全身に紫斑を生じ，感染性電撃性紫斑病として当院救命救急センターへ搬送された。来院時APACHE IIスコア 14点，SOFAスコア 8点，急性期DICスコア 8点であった。末梢血でHowell–Jolly小体が認められ，血液スメアでグラム陰性桿菌が検出された。第5病日に患者が飼い犬に頻回に咬まれていたことが判明し，検査結果と併せてCapnocytophaga感染症を疑い，抗菌薬をスルバクタム/アンピシリンとクリンダマイシンに変更した。第6病日に原因菌はCapnocytophaga canimorsusと確定した。播種性血管内凝固症候群（DIC）に対してはトロンボモデュリン製剤の投与と血小板の補充を行った。電撃性紫斑を呈した四肢末端は壊死し切断術が必要な状態となったが，その他の部分は発症前と同程度にまで改善した。本症例は比較的若年の明確な免疫不全既往のない患者に発症し，電撃性紫斑病・DICを合併したCapnocytophaga感染症であり，劇症化には潜在的な脾機能低下の関与が示唆された。

クローン病術後に合併した急性感染性電撃性紫斑病の1例

クローン病術後に合併した急性感染性電撃性紫斑病の1例

Acute infectious purpura fulminans caused by group A β-hemolytic Streptococcus: An uncommon organism.

Acute infectious purpura fulminans caused by group A β-hemolytic Streptococcus: An uncommon organism.

Purpura Fulminans and Pasteurella Multocida Infection in an Adult: A Case Report

Introduction: Purpura fulminans (PF) is a rare rapidly progressive disease caused by microvascular thrombosis of skin vessels manifested as characteristic skin lesions. Three different subtypes have been described: neonatal, idiopathic and acute infectious. Treatment depends on subtype and may include antibiotic therapy, supportive treatment and transfusions (mainly fresh frozen plasma (FFP)). Case presentation: A fifty nine-year-old female presented at emergency department with nausea, vomit, diarrhea and abdominal pain. She was hypotensive, tachycardic, jaundiced and had mild epigastric tenderness. Analysis revealed pancytopenia, coagulopathy, renal failure and hyperbilirubinemia. Arterial blood gas analyses showed compensated metabolic acidosis and hyperlactacidemia. Patient was started on vasopressor therapy for hypotension unresponsive to fluids. Nevertheless, her condition deteriorated and severe metabolic acidosis developed. A purpuric rash developed initially at left thigh and spread through abdomen and thorax. Patient was transferred to an intensive care unit after resuscitation from a cardiorespiratory arrest. Large spectrum antibiotic therapy and renal replacement technique were started as well as transfusion with platelets, FFP and red blood cells. Susceptible Pasteurella multocida was present in two hemocultures. Despite maximal supportive treatment patient's condition deteriorated and dyed 72 hours after admission. Discussion: We described a case of severe acute infectious PF presenting in an adult with Pasteurella multocida bacteriemia. The uniqueness of this case report lye on the rarity of PF in adults and on being to our knowledge the first case described of PF caused by Pasteurella multocida infection.

Spectrum of purpura fulminans: Report of three classical prototypes and review of management strategies

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and is accompanied by vascular collapse and disseminated intravascular coagulation. It usually occurs in children, but this syndrome has also been noted in adults. The three forms of this disease are classified by the triggering mechanisms. We describe three classical cases of purpura fulminans of the three classical prototypes treated at our center and their varied clinical outcomes. We also describe a case of acute infectious purpura fulminans secondary to systemic leptospirosis which to our best knowledge is the first reported case in world literature. The various treatment options for purpura fulminans have also been reviewed.

Surgical Management of Acute Infectious Purpura Fulminans

Purpura fulminans is a syndrome characterized by hemorrhagic infarction of the skin and underlying soft tissue as a result of disseminated intravascular coagulation and intravascular thrombosis. In this study, the authors report their experience with surgical intervention for acute infectious purpura fulminans (AIPF). A retrospective chart review was performed including all patients diagnosed with AIPF from January 1, 2006, to December 31, 2008, and treated at an academic medical center. Primary endpoints of interest were overall survival rate and the need for and level of eventual amputation. Improvement in limb perfusion was included as a secondary endpoint. Nine patients were diagnosed with AIPF at the authors' institution during a 3-year period, and seven of these diagnoses were made within 12 months. Overall mortality was 44% (5/9). Amputation was required in 80% of survivors (4/5). All patients explored within 24 hours of diagnosis had evidence for compartment syndrome with visible bulging muscle on fascial release. AIPF is a devastating disease with significant mortality and morbidity primarily related to the loss of multiple limbs. This study suggests that early diagnosis and surgical intervention in the form of compartment release and sympathectomy should be performed concurrently with the initial treatment of sepsis to minimize amputations in surviving patients.

Inpatient Rehabilitation of Survivors of Purpura Fulminans With Multiple Limb Amputations: A Case Series

Shapiro LT, Huang ME. Inpatient rehabilitation of survivors of purpura fulminans with multiple limb amputations: a case series. Purpura fulminans (PF) is a rare, rapidly progressive syndrome characterized by intravascular thrombosis and necrosis of the skin and subcutaneous tissues. Survivors are often left with considerable impairments, including organ dysfunction, adjustment disorder, extensive wounds, and amputations. This retrospective case series presents 4 adult patients who underwent multiple limb amputations secondary to acute infectious PF. All patients underwent acute inpatient rehabilitation, were fitted with prostheses during their stay, and achieved a minimal assistance level for most of their self-care and mobility skills. Rehabilitation management is discussed, including common medical issues, complications, and prosthetic considerations.

電撃性紫斑病の臨床的検討―本邦における原因菌の特徴を含めて―

Acute infectious purpura fulminans (AIPF), a rare syndrome of infection-induced ischemic necrosis of the extremities (symmetric peripheral gangrene), is due most often to Neisseria meningitidis in the US and the UK, but is not endemic to Japan. We reviewed clinical AIPF manifestations in Japan. (A) We retrospectively analyzed six cases of AIPF in the last seven years. (B) We reviewed the medical literature up to 2008 using PubMed search and Japana Centra Revuo Medicina (Igakuchuozasshi) findings. (A) None of the 6 subjects-5 men and 1 woman aged 44 to 69 old- had a history of splenectomy. Except for one case, their disease was community-acquired and immunocompetent. Causative organisms were Streptococcus pneuomoniae (66.7%), Gram negative rods, and Legionella pneumophilla. No localized infectious focus was apparent except for one of Legionella pneumonia. Systemic purpura progressed rapidly within 12 to 96 hours of initial fever or influenza-like symptoms. Main AIPF manifestations are shock and disseminated intervascular coagulation, but not all subjects had both. Six-month mortality was 33.3%, with death within two days of admission. Survivors all required at least two limbs to be amputated. (B) The Japanese literature reported AIPF occurring in 64 cases- 11 neonatal due to congenital protein C deficiency, seven pediatric, and 46 adults. Organisms most commonly involved were S. pneumoniae at 41.3%, and Neisseria meningitidis at 15.2%. The most common pathogen reported in a PubMed search was Neisseria meningitidis. In Japan, S. pneumoniae is the most frequent isolate associated with AIPF, and progression to AIPF occurs mainly in adults, who commonly suffer frequent amputations and high mortality. Rapid progressing systemic purpura following common-cold-like symptoms is the key to early diagnosis, even if the patient is immunocompetent, not splenectomized, or has no apparent infectious foci.

Purpura Fulminans in a Patient with Rheumatoid Arthritis

© 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.

Modern Concepts of the Diagnosis and Treatment of Purpura Fulminans

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and accompanied by vascular collapse and disseminated intravascular coagulation. It usually occurs in children, but this syndrome has also been noted in adults. The purpose of this collective review is to provide modern concepts on the diagnosis and treatment of neonatal purpura fulminans, idiopathic purpura fulminans, and acute infectious purpura fulminans. There are three forms of this disease that are classified by the triggering mechanisms. First, neonatal purpura fulminans is associated with a hereditary deficiency of the natural anticoagulants Protein C and Protein S as well as Antithrombin III. Idiopathic purpura fulminans usually follows an initiating febrile illness that manifests with rapidly progressive purpura. Deficiency of Protein S is considered to be central to the pathogenesis of this form of the disease. The third and most common type of purpura fulminans is acute infectious purpura fulminans. The mortality rate has decreased with better treatment of secondary infections, supportive care, and new treatments, but it remains a disabling condition often requiring major amputations.

Massive Soft Tissue Infections: Necrotizing Fasciitis and Purpura Fulminans

Necrotizing fasciitis and purpura fulminans are two destructive infections that involve both skin and soft tissue. Necrotizing fasciitis is characterized by widespread necrosis of subcutaneous tissue and the fascia. Historically, group A beta-hemolytic streptococcus has been identified as a major cause of this infection. However, this monomicrobial infection is usually associated with some underlying cause, such as diabetes mellitus. During the last two decades, scientists have found that the pathogenesis of necrotizing fasciitis is polymicrobial. The diagnosis of necrotizing fasciitis must be made as soon as possible by examining the skin inflammatory changes. Magnetic resonance imaging is strongly recommended to detect the presence of air within the tissues. Percutaneous aspiration of the soft tissue infection followed by prompt Gram staining should be conducted with the "finger-test" and rapid-frozen section biopsy examination. Intravenous antibiotic therapy is one of the cornerstones of managing this life-threatening skin infection. Surgery is the primary treatment for necrotizing fasciitis, with early surgical fasciotomy and debridement. Following debridement, skin coverage by either Integra Dermal Regeneration Template or AlloDerm should be undertaken. Hyperbaric oxygen therapy complemented by intravenous polyspecific immunoglobulin are useful adjunctive therapies. Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin; it is rapidly progressive and accompanied by vascular collapse. There are three types of purpura fulminans: neonatal purpura fulminans, idiopathic or chronic purpura fulminans, and acute infectious purpura fulminans. Clinical presentation of purpura fulminans involves a premonitory illness followed by the rapid development of a septic syndrome with fever, shock, and disseminated intravascular coagulation. The diagnosis and treatment of these conditions is best accomplished in a regional burn center in which management of multiple organ failure can be conducted with aggressive debridement and fasciotomy of the necrotic skin. The newest revolutionary advancement in the treatment of neonatal purpura fulminans is the use of activated protein C.

Clinical microbiological case: a necrotic skin lesion in a patient with renal failure

Clinical microbiological case: a necrotic skin lesion in a patient with renal failure

Acute Infectious Purpura Fulminans: A 15-Year Retrospective Review of 28 Consecutive Cases

Acute infectious purpura fulminans (AIPF) is a rare syndrome of hemorrhagic infarction of the skin, extremity loss, and intravascular thrombosis. It progresses rapidly and is accompanied by disseminated intravascular coagulation and vascular collapse. The victims often succumb to the disease. Our objective was to investigate the clinical manifestations, outline the clinical course, and delineate factors related to mortality among the patients with AIPF. Patients diagnosed with AIPF over a 15-year period were reviewed retrospectively for patient history, comorbid conditions, progression of clinical course, and medical and surgical management. The vast majority of the patients were under the age of 7; however, the disease process can be seen in adults. The overall mortality rate was 43 per cent. The major predisposing factors were history of recent upper respiratory infection, recent surgery or childbirth, young age, and absence of a spleen. The most common clinical manifestations were skin discoloration, disseminated intravascular coagulation, fever, and septic shock. The most common bacteria cultures were Neisseria meningitidis, Hemophilus influenzae, and Streptococcus pneumoniae. There appears to be a higher mortality in patients who did not undergo a surgical intervention. Compartment syndrome needs to be evaluated early on in the presentation. Rapid diagnosis, intensive care unit management, and prompt surgical consultation and debridement may decrease the mortality.

Acute infectious purpura fulminans associated with asplenism or hyposplenism

Acute infectious purpura fulminans is a rapidly progressive syndrome of hemorrhagic skin necrosis associated with acute infection and disseminated intravascular coagulation. We report 5 cases of purpura fulminans and briefly review the literature. All cases were associated with encapsulated organisms (Streptococcus pneumoniae or Group A streptococcus), and 4 of the 5 patients had asplenism or functional hyposplenism. (J Am Acad Dermatol 2002;47:493-6.)