scholarly journals Four-extremity amputation following disseminated intravascular coagulation and purpura fulminans

2019 ◽  
Vol 12 (3) ◽  
pp. e228028 ◽  
Author(s):  
Umar F Bhatti ◽  
Aaron M Williams ◽  
Krishnan Raghavendran ◽  
Patrick E Georgoff
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Complex Disease ◽  
Purpura Fulminans ◽  
Limb Amputation ◽  
Healthy Baby ◽  
Intravascular Coagulation ◽  
Septic Episode ◽  
Extremity Amputation ◽  
Infectious Source ◽  
New Onset

Purpura fulminans (PF) is a rare but serious complication of septic shock in adults. The complex disease course makes it challenging to manage the condition. Here, we present the case of a healthy young woman who presented with sepsis and new-onset erythematous lesions 4 days after the vaginal delivery of a healthy baby. The infectious source could not be identified, and the patient was started on antibiotics and resuscitated. However, her condition worsened, and she developed disseminated intravascular coagulation and PF. The septic episode slowly decreased in severity, but she sustained extensive ischaemic injuries to her extremities, for which she underwent four-limb amputation.

scholarly journals SYMMETRICAL PERIPHERAL GANGRENE OF BILATERAL HANDS AND UNILATERAL FOOT IN SETTING OF SEPTIC SHOCK REQUIRING PROLONGED HIGH DOSE VASOPRESSORS

2020 ◽  
Vol 8 (12) ◽  
pp. 952-954
Author(s):  
Ajinkyabhosle a ◽  
Ramesh Patankar
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Purpura Fulminans ◽  
Limb Amputation ◽  
High Dose ◽  
Low Cardiac Output ◽  
Prolonged Hospitalisation ◽  
Intravascular Coagulation ◽  
Root Cause ◽  
Peripheral Gangrene

Symmetrical peripheral gangrene (SPG) is characterized by progressive ischemic damage in two or more extremities, without large vessel obstruction. This syndrome has been reported in several etiologies such as infections, disseminated intravascular coagulation (DIC), and low cardiac output states. It is also known as purpura fulminans (PF). It carries a risk of limb amputation leading long term morbidity and higher rates of mortality due to prolonged hospitalisation.1 SPG is the sign of progressive disseminated intravascular coagulation (DIC). The main pathogenesis theory, is microthrombosis associated with disturbed pro coagulant–anticoagulant balance, leading to tissue necrosis. The treatment thus involves aggressive treatment of root cause and theoretically involves heparin-based anticoagulation.2.

Purpura Fulminans in a Chinese Boy With Congenital Protein C Deficiency

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 670-676
Author(s):  
Patrick Yuen ◽  
Alfred Cheung ◽  
Hsiang Ju Lin ◽  
Faith Ho ◽  
Jun Mimuro ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Protein C ◽  
Purpura Fulminans ◽  
Fresh Frozen Plasma ◽  
Protein C Deficiency ◽  
Intravascular Coagulation ◽  
The Family ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Congenital Protein C Deficiency

Severe and recurrent purpura fulminans developed in a Chinese boy at one day of age. Results of coagulation studies performed on the patient during attacks were compatible with the diagnosis of disseminated intravascular coagulation. Subsequent investigations have revealed that the patient is homozygous and that his parents are heterozygous for protein C deficiency. Cryoprecipitate and fresh frozen plasma induced a remission, and administration of warfarin has been successful in preventing recurrence of attacks for as long as 8 months without infusion of any plasma components. None of the family members who are heterozygous for protein C deficiency have had thrombotic episodes.

scholarly journals Purpura Fulminans following Thermal Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Jiongyu Hu ◽  
Xupin Jiang ◽  
Ting He ◽  
Qizhi Luo
Keyword(s):  
Organ Dysfunction ◽  
Disseminated Intravascular Coagulation ◽  
Thermal Injury ◽  
Purpura Fulminans ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Small Children ◽  
Intravascular Coagulation ◽  
Intravascular Thrombosis ◽  
First Case

Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin, which is an unusual cutaneous manifestation of disseminated intravascular coagulation. It often occurs in small children and babies due to infection and/or sepsis, rarely in adults in clinic. We report the first case of deadly purpura fulminans following thermal injury in a 64-year-old Chinese woman. The purpura developed sharply and aggravated multiple organ dysfunction. The patient died of purpura fulminans, disseminated intravascular coagulation, and multiple organ dysfunction syndrome.

scholarly journals Disseminated intravascular coagulation in an under-recognised zoonotic infection

2017 ◽  
Vol 16 (3) ◽  
pp. 138-141
Author(s):  
Sarah Lawrence ◽  
◽  
Andrew Claxton ◽  
Mark Holland ◽  
Jack Hodd ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Purpura Fulminans ◽  
Blood Cultures ◽  
Organ Support ◽  
Zoonotic Infection ◽  
Intravascular Coagulation ◽  
Prompt Treatment ◽  
History Of

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

scholarly journals Disseminated Intravascular Coagulation With Purpura Fulminans Presentation of Acute Promyelocytic Leukemia

2019 ◽  
Vol 3 (4) ◽  
pp. 446-448
Author(s):  
Douglas Ader ◽  
Muhammad Durrani ◽  
Eric Blazar
Keyword(s):  
Emergency Department ◽  
Acute Promyelocytic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
Early Recognition ◽  
Survival Rates ◽  
Purpura Fulminans ◽  
Promyelocytic Leukemia ◽  
Intravascular Coagulation ◽  
Remission Rates

A 47-year-old male presented to the emergency department with 12 hours of nausea, vomiting, abdominal pain, and a widespread skin eruption with mottled, irregular, purpuric lesions with subsequent rapid decompensation. Laboratory analysis revealed thrombocytopenia, bandemia, elevated metamyelocytes, abnormal coagulation panel, decreased fibrinogen, elevated fibrin split products, renal dysfunction, bacterial rods, dohle bodies, and toxic granulation. Acute promyelocytic leukemia (APML) was confirmed via bone marrow biopsy, flow cytometry, and fluorescence in situ hybridization analysis. Disseminated intravascular coagulation (DIC) may be the initial presentation of APML. When treated promptly, APML can achieve high remission rates; however, conditions such as DIC continue to increase mortality requiring early recognition to improve survival rates.

Purpura Fulminans Induced by Disseminated Intravascular Coagulation following Infection in 2 Unrelated Children with Double Heterozygosity for Factor V Leiden and Protein S Deficiency

1997 ◽  
Vol 77 (06) ◽  
pp. 1086-1089 ◽  
Author(s):  
Aida Inbal ◽  
Gilly Kenet ◽  
Ariella Zivelin ◽  
Tikva Yermiyahu ◽  
Tamar Bronstein ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Viral Infections ◽  
Purpura Fulminans ◽  
Factor V Leiden ◽  
Protein S ◽  
Factor V ◽  
Protein S Deficiency ◽  
Intravascular Coagulation ◽  
Inhibitory Mechanisms ◽  
S Deficiency

SummaryPurpura fulminans is associated with homozygous protein C and homozygous protein S deficiency or may follow bacterial or viral infections. We present 2 children from 2 unrelated Arab families with purpura fulminans who were double heterozygotes for factor V Leiden inherited from their fathers and protein S deficiency inherited from their mothers. No previous thrombotic events have occured in either patient or their respective family members. In one patient sepsis accompanied by disseminated intravascular coagulation appeared to be the trigger of purpura fulminans. In the other patient varicella infection preceded purpura fulminans and was also associated with disseminated intravascular coagulation. This report emphasizes the need for evaluation of hereditary defects in the inhibitory mechanisms of blood coagulation in patients with purpura fulminans at any age.

scholarly journals Neisseria meningitidis Induced Fatal Waterhouse–Friderichsen Syndrome in a Patient Presenting With Disseminated Intravascular Coagulation and Multiple Organ Failure

2020 ◽  
Vol 10 (3) ◽  
pp. 171 ◽  
Author(s):  
Meng-Yu Wu ◽  
Chien-Sheng Chen ◽  
Chih-Yi Tsay ◽  
Giou-Teng Yiang ◽  
Jian-Yu Ke ◽  
...  
Keyword(s):  
Multiple Organ Failure ◽  
Neisseria Meningitidis ◽  
Organ Failure ◽  
Disseminated Intravascular Coagulation ◽  
Meningococcal Disease ◽  
Purpura Fulminans ◽  
Multiple Organ ◽  
High Grade Fever ◽  
Intravascular Coagulation ◽  
Fatal Septicemia

Neisseria meningitidis-induced acute systemic meningococcal disease is an emergency and a fatal condition that has a high mortality rate. In patients with a fulminant infection, a maculopapular petechial eruption, purpura fulminans, or an ecchymotic lesion are worrisome signs reflecting disseminated intravascular coagulation (DIC) and hint at Waterhouse–Friderichsen syndrome (WFS). Here, we describe a rare case of a patient with a fulminant Neisseria meningitidis-induced acute systemic meningococcal disease presenting with high-grade fever without meningitis symptoms. Fatal septicemia with DIC and multiple organ failure was noted. WFS was chiefly suspected. We highlight the clinical features and pathogenesis of Neisseria meningitidis-induced meningococcemia and WFS. We propose that they should be kept in mind, especially in patients presenting with a petechial eruption and purpura fulminans.

Sign in / Sign up

Export Citation Format

Share Document