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Li XL, Luan CY, Fan YJ, Lin XY, Jiang D, Su MX, Wang G, Yang X. A Rare Case of Acute Infectious Purpura Fulminans Caused by Klebsiella Pneumoniae and Human Herpesvirus Type 5. J Inflamm Res 2022; 15:4251-4260. [PMID: 35923907 PMCID: PMC9340174 DOI: 10.2147/jir.s369986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Purpura 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 Report This 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. Conclusion Adults 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.
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Affiliation(s)
- Xiao-Lan Li
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
- Correspondence: Xiao-Lan Li, Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, No. 374 of Dian-Mian Avenue, Wu-Hua District, Kunming, 650101, People’s Republic of China, Tel +86 871 63402212, Fax +86 871 65334416, Email
| | - Chun-Yan Luan
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Ying-Jun Fan
- Department of Rheumatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Xiao-Ying Lin
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Dong Jiang
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Mei-Xian Su
- Department of Emergency Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Gang Wang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
| | - Xu Yang
- Laboratory Bacteria Room, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People’s Republic of China
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Rana K, Gupta A, Sood A, Gupta M. Factors leading to neonatal mortality due to neonatal purpura fulminans through the lens of a child death review. BMJ Case Rep 2021; 14:e237281. [PMID: 34167969 PMCID: PMC8230994 DOI: 10.1136/bcr-2020-237281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/04/2022] Open
Abstract
A case of neonatal death due to neonatal purpura fulminans (NPF) was brought to community physicians' notice by the auxiliary nurse midwife in her catchment area as part of the routine demographic health surveillance. The community physician then conducted the child death review in the community. The neonate was born out of consanguineous marriage (mother married to her first-degree maternal cousin) with spontaneous conception. This neonate was fourth in the birth order. The second-order and third-order births had also suffered from NPF and died. The baby was delivered in a tertiary care setting, and the paediatric surgeon planned debridement of the affected part on the third day of the birth, as per the mother. However, due to inadequate counselling regarding the procedure, mother left the hospital without seeking care against medical advice, and the child died at home.
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Affiliation(s)
- Kirtan Rana
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Sood
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Asif M, Quiroga L, Lagziel T, Ladd SB, Caffrey J. A Multidisciplinary Approach to the Management of Severe Purpura Fulminans in a Burn Center: A Case Series. Cureus 2019; 11:e5478. [PMID: 31646137 PMCID: PMC6805038 DOI: 10.7759/cureus.5478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpura fulminans is a life-threatening hematological emergency characterized by skin necrosis and disseminated intravascular coagulation requiring rapid diagnosis and treatment. We present a case series of patients with severe purpura fulminans who were managed via a multidisciplinary approach at a regional burn center. We report the burn unit perspective which includes current intensive care guidelines with early surgical intervention, in addition to a review of the pathology and clinical features of the disease. Proper wound management and expeditious surgical evaluation can help reduce the mortality and minimize amputations. Early referral to a burn center with a multidisciplinary team is recommended for the best outcomes in these patients.
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Affiliation(s)
- Mohammed Asif
- Surgery, Burn Center, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Luis Quiroga
- Surgery, Burn Center, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Tomer Lagziel
- Medicine, Burn Center, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Seth B Ladd
- General Surgery, St. John's Episcopal Hospital, Far Rockaway, USA
| | - Julie Caffrey
- Surgery, Burn Center, The Johns Hopkins University School of Medicine, Baltimore, USA
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4
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Purpura fulminans following immediate bilateral breast reconstruction: A case report and literature review. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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5
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Nicolas L, Philip J, Larson S, Islam S, Lew JF, Glavin FL, Samraj RS. Severe Neonatal Purpura Fulminans Caused by Staphylococcus aureus. Clin Pediatr (Phila) 2017; 56:776-780. [PMID: 27449990 DOI: 10.1177/0009922816660693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lara Nicolas
- 1 Department of Pediatrics, Shands Children's Hospital, UF Health, Gainesville, FL, USA
| | - Joseph Philip
- 1 Department of Pediatrics, Shands Children's Hospital, UF Health, Gainesville, FL, USA
| | - Shawn Larson
- 2 Department of Surgery, Shands Children's Hospital, UF Health, Gainesville, FL, USA
| | - Saleem Islam
- 2 Department of Surgery, Shands Children's Hospital, UF Health, Gainesville, FL, USA
| | - Judy F Lew
- 1 Department of Pediatrics, Shands Children's Hospital, UF Health, Gainesville, FL, USA
| | | | - Ravi S Samraj
- 1 Department of Pediatrics, Shands Children's Hospital, UF Health, Gainesville, FL, USA
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Pasquesoone L, Belkhou A, Gottrand L, Guerreschi P, Duquennoy-Martinot V. [Management of purpura fulminans lesions in children]. ANN CHIR PLAST ESTH 2016; 61:605-612. [PMID: 27289551 DOI: 10.1016/j.anplas.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10 days and 3 weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.
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Affiliation(s)
- L Pasquesoone
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France.
| | - A Belkhou
- Clinique de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - L Gottrand
- Centre de rééducation Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-d'Ascq, France
| | - P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brûlés, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille cedex, France
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7
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Meher BK, Pradeep S, Pradhan DD, Patra KP, Mohanty N. Purpura of all four limbs with gangrene in a child with Juvenile Idiopathic Arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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8
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Albarrak M, Al-Matary A. Neonatal purpura fulminans manifestation in early-onset group B Streptococcal infection. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:315-7. [PMID: 23970945 PMCID: PMC3748862 DOI: 10.12659/ajcr.889352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/12/2013] [Indexed: 12/03/2022]
Abstract
Patient: Male, 0 Final Diagnosis: Purpura fulminans Symptoms: Fever • letargy Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology
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Fitzgerald CJ, Pranikoff TV, Ross GA, Mou S, Givner LB, Shetty AK. Purpura fulminans caused by community-associated methicillin-resistant Staphylococcus aureus. Am J Emerg Med 2011; 30:1013.e1-4. [PMID: 21641144 DOI: 10.1016/j.ajem.2011.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/31/2011] [Indexed: 11/17/2022] Open
Abstract
Sepsis-induced purpura fulminans is a rare but life-threatening condition characterized by rapidly progressive hemorrhagic infarction of the skin due to dermal vascular thrombosis resulting in tissue loss and severe scarring. Although most commonly related to meningococcal or invasive group A streptococcal disease, it may also be caused by several other bacterial or viral pathogens including Pneumococcus and Varicella. Purpura fulminans associated with Staphylococcus aureus sepsis is rare but has been reported in adults. However, the syndrome is very unusual in children, and to our knowledge, only 2 cases of staphylococcal purpura fulminans have been reported in children, both due to methicillin-susceptible S aureus in the United Kingdom. We report the first well-described case of purpura fulminans due to community-associated methicillin-resistant S aureus in a child.
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Affiliation(s)
- Casimir J Fitzgerald
- Department of Surgery, Wake Forest University School of Medicine and Brenner Children's Hospital, Winston Salem, NC, USA
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10
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Abstract
Enterocutaneous fistula in newborns and preterms is a well-recognized complication after necrotizing enterocolitis and abdominal surgical procedures/percutaneous interventions. However, to our knowledge, enterocutaneous fistula associated with purpura fulminans has not been reported before. Herein we report a preterm infant with purpura fulminans who developed cutaneous necrotic lesions on anterior abdominal wall. Adherence of necrotic abdominal skin to the adjacent intestinal wall resulted in enterocutaneous fistula. The patient was treated conservatively with bowel rest and antibiotics. The fistula was surgically closed 2 months later.
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11
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Hon KL, So KW, Wong W, Cheung KL. Spot diagnosis: An ominous rash in a newborn. Ital J Pediatr 2009; 35:10. [PMID: 19490602 PMCID: PMC2698843 DOI: 10.1186/1824-7288-35-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 04/30/2009] [Indexed: 01/09/2023] Open
Abstract
Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia. PF in the newborn is rarely reported. We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS) septicemia. She developed multi-organ system failure despite neonatal intensive care support and succumbed 9 days later. GBS, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics. PF associated with GBS is a rare cutaneous sign that must not be missed. Mortality remains high despite aggressive treatment and ICU support.
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Affiliation(s)
- Kam-Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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12
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13
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Pollard RLE, Kennedy PJ, Maitz PKM. The use of artificial dermis (Integra) and topical negative pressure to achieve limb salvage following soft-tissue loss caused by meningococcal septicaemia. J Plast Reconstr Aesthet Surg 2007; 61:319-22. [PMID: 18078796 DOI: 10.1016/j.bjps.2007.10.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 03/19/2007] [Accepted: 10/09/2007] [Indexed: 10/22/2022]
Abstract
Meningococcal sepsis leading to purpura fulminans leaves survivors with extensive areas of skin and soft-tissue necrosis. Soft-tissue loss in the limbs may result in large areas of exposed bone, leaving a choice between free tissue transfer and amputation. We present a case of meningococcal sepsis where the entire medial and lateral surfaces of the tibiae were exposed with loss of anterior muscle compartments on each side. Faced with the possibility of bilateral above-knee amputation, these were instead covered using the dermal replacement Integra (Integra LifeSciences Corp.), in conjunction with an antimicrobial dressing, topical negative pressure dressing and subsequent skin grafting. This management decision achieved rapid wound closure avoiding amputation. Additional secondary reconstruction with microvascular free flaps was performed to preserve joint function.
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Affiliation(s)
- Rebecca L E Pollard
- Burns Unit, Concord Repatriation General Hospital, Hospital Road, Sydney, 2139 NSW, Australia.
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14
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Abdulmalik A, Al-Ateeqi W, Al-Khawari M, Al-Osaimi S. Varicella-associated purpura fulminans: chicken pox is not always benign. Med Princ Pract 2006; 15:232-4. [PMID: 16651842 DOI: 10.1159/000092188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 01/04/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a 6-year-old boy with post-chicken pox purpura fulminans (PF). CLINICAL PRESENTATION AND INTERVENTION A 6-year-old boy presented with purpura of the legs that rapidly progressed to other parts of the limbs and the buttocks. The patient had had chicken pox 10 days prior to presentation. He was afebrile and the chicken pox lesions were dry. He received anti-coagulants, a large volume of fresh frozen plasma, immunoglobulin and steroids. The skin lesions regressed but both hands and parts of the lower limbs remained necrotic; the patient was transferred to an orthopaedic hospital for amputation and skin grafting. CONCLUSION This case report shows that PF can occur as a post-infection syndrome after primary varicella. Early and aggressive treatment of post-chicken pox PF might reduce the mortality and morbidity associated with this condition.
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Affiliation(s)
- A Abdulmalik
- Department of Paediatrics, Al-Amiri Hospital, Safat, Kuwait
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15
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Sheridan RL, Tompkins RG. What's new in burns and metabolism. J Am Coll Surg 2004; 198:243-63. [PMID: 14759783 DOI: 10.1016/j.jamcollsurg.2003.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 11/10/2003] [Indexed: 12/31/2022]
Affiliation(s)
- Robert L Sheridan
- Burn Surgery Service, Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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16
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Warner PM, Kagan RJ, Yakuboff KP, Kemalyan N, Palmieri TL, Greenhalgh DG, Sheridan RL, Mozingo DW, Heimbach DM, Gibran NS, Engrav L, Saffle JR, Edelman LS, Warden GD. Current management of purpura fulminans: a multicenter study. THE JOURNAL OF BURN CARE & REHABILITATION 2003; 24:119-26. [PMID: 12792230 DOI: 10.1097/01.bcr.0000066789.79129.c2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Seven burn centers performed a 10-yr retrospective chart review of patients diagnosed with purpura fulminans. Patient demographics, etiology, presentation, medical and surgical treatment, and outcome were reviewed. A total of 70 patients were identified. Mean patient age was 13 yr. Neisseria meningitidis was the most common etiologic agent in infants and adolescents whereas Streptococcus commonly afflicted the adult population. Acute management consisted of antibiotic administration, volume resuscitation, ventilatory and inotropic support, with occasional use of corticosteroids (38%) and protein C replacement (9%). Full-thickness skin and soft-tissue necrosis was extensive, requiring skin grafting and amputations in 90% of the patients. One fourth of the patients required amputations of all extremities. Fasciotomies when performed early appeared to limit the level of amputation in 6 of 14 patients. Therefore, fasciotomies during the initial management of these patients may reduce the depth of soft-tissue involvement and the extent of amputations.
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Affiliation(s)
- P M Warner
- Shriners Hospitals for Children, Cincinnati, Ohio 45229, USA
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17
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Greenberg JE, Falabella AF, Bello YM, Schachner LA. Tissue-engineered skin in the healing of wound stumps from limb amputations secondary to purpura fulminans. Pediatr Dermatol 2003; 20:169-72. [PMID: 12657020 DOI: 10.1046/j.1525-1470.2003.20218.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Currently wound treatment options of amputation stumps due to purpura fulminans include healing by secondary intention from wound debridement, split-thickness skin grafting, tissue and muscle flaps, plantar skin free transfer, skin expansion, artificial skin, and hyperbaric oxygen therapy. We saw a 6-month-old girl with purpura fulminans as a complication of meningococcemia. She developed necrosis of the distal extremities resulting in bilateral amputation of the lower limbs. Shortly thereafter the leg stumps also became necrosed and she underwent unsuccessful split-thickness grafts of lower limb ulcers. The patient's difficult-to-heal wounds made her an excellent candidate for treatment with tissue-engineered skin. At 10 months of age, this was applied to her previously nonhealing wounds. The tissue-engineered skin induced rapid healing of the patient's chronic amputation stump ulcers and provided her with substantial pain relief. In conclusion, tissue-engineered skin appears to be a potential beneficial treatment for chronic wounds in children with nonhealing amputation stumps.
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Affiliation(s)
- J E Greenberg
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA
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19
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Abstract
Acute infectious purpura fulminans is reported in a 16-month-old male with a history of posttraumatic asplenia and complete left brachial plexus palsy. This patient developed peripheral necrosis of both lower extremities and the right upper extremity, whereas the left upper extremity was completely spared from ischemia and tissue damage. Amputation of four digits on the right hand and debridement of both lower extremities were required. This patient demonstrated the protective effect of a traumatic sympathectomy, which suggests the requirement of an intact sympathetic reflex in the development of purpura fulminans.
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Affiliation(s)
- T M Willis
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198-5165, USA
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20
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Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001; 107:1025-35. [PMID: 11252099 DOI: 10.1097/00006534-200104010-00019] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LEARNING OBJECTIVES After studying the article, the participant should be able to: 1. Describe the most common bacteriology of necrotizing fasciitis and purpura fulminans. 2. Describe the "finger test" in the diagnosis of necrotizing fasciitis. 3. Discuss the three presentation patterns of necrotizing fasciitis. 4. Discuss the pathophysiology of acute infectious purpura fulminans. 5. Discuss the treatment strategies for necrotizing fasciitis and purpura fulminans, including the use of artificial skin substitutes. Necrotizing fasciitis and purpura fulminans are two destructive processes that involve skin and soft tissues. The plastic and reconstructive surgeon may frequently be called on for assistance in the diagnosis, treatment, and/or reconstruction of patients with these conditions. Understanding the natural history and unique characteristics of these processes is essential for effective surgical management and favorable patient outcome. A comprehensive review of the literature pertaining to these two conditions is presented, outlining the different pathophysiologies, the patterns of presentation, and the treatment strategies necessary for successful management of these massive infectious soft-tissue diseases.
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Affiliation(s)
- T J Andreasen
- Division of Plastic and Reconstructive Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Abstract
Purpura fulminans (PF) is a haemorrhagic condition usually associated with sepsis or previous infection. Features include tissue necrosis, small vessel thrombosis and disseminated intravascular coagulation. Gram-negative organisms are the commonest cause of the acute infectious type, which is often associated with multi-organ failure. An idiopathic variety, however, is often confined to the skin. 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. We describe two cases and review the various treatments for this condition.
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Affiliation(s)
- J Nolan
- Department of Anaesthesia, Treliske Hospital, Truro, Cornwall, UK
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22
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Arévalo JM, Lorente JA, Fonseca R. Surgical treatment of extensive skin necrosis secondary to purpura fulminans in a patient with meningococcal sepsis. Burns 1998; 24:272-4. [PMID: 9677033 DOI: 10.1016/s0305-4179(97)00120-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Meningococcal sepsis is associated with a high mortality rate. These patients may show severe disseminated intravascular coagulation (DIC) and skin necrosis. There is very little published experience regarding the surgical treatment of this complication. The similarity between skin necrosis secondary to DIC and full thickness cutaneous burns provides the rationale for its treatment as if it was a deep burn. We report the surgical treatment of extensive skin necrosis in a patient with meningococcal sepsis and DIC. This treatment is similar to that used in full thickness burns, including excision of necrotic tissue and coverage with autografts, as well as amputation of extremities if distal coverage is not possible.
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Affiliation(s)
- J M Arévalo
- Servicio de Cirugía Plástica y Unidad de Grandes Quemados, Hospital Universitario de Getafe, Madrid, Spain
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23
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Sheridan RL. The seriously burned child: resuscitation through reintegration--2. CURRENT PROBLEMS IN PEDIATRICS 1998; 28:139-67. [PMID: 9615186 DOI: 10.1016/s0045-9380(98)80061-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R L Sheridan
- Acute Burn Service, Shriners Burns Hospital, Boston, USA
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