Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study

Contou, Damien; Sonneville, Romain; Canouï‐Poitrine, Florence; Colin, Gwenhaël; Coudroy, Rémi; Pène, Frédéric; Tadié, Jean‐Marc; Cour, Martin; Béduneau, G.; Marchalot, Antoine; Guérin, Laurent; Jochmans, Sébastien; Ehrmann, Stéphan; Terzi, Nicolas; Preau, Sébastien; Barbier, François; Schnell, Guillaume; Roux, Damien; Leroy, Olivier; Pichereau, Claire; Gelisse, E.; Zafrani, Lara; Layese, Richard; Brun‐Buisson, Christian; Dessap, Armand Mekontso; Prost, Nicolas de

doi:10.1007/s00134-018-5341-3

Cited by 40 publications

(55 citation statements)

References 28 publications

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“…A total of 190 patients age ≥ 15 years were diagnosed with PF and underwent a surgical procedure. There were 68 case studies [1, 6, 12–25, 27, 29, 31–40, 43–45, 47–61, 63, 65–72, 74, 75, 77–87], nine case series [8, 26, 30, 41, 42, 46, 64, 73, 76], one prospective cohort [62], and one retrospective cohort [28] studies published in English. All outcomes queried were identifiable during data extraction.…”

Section: Resultsmentioning

confidence: 99%

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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Background Cutaneous manifestations of purpura fulminans (PF) present many challenges for clinicians and surgeons. In a state of septic shock complicated by limb ischemia, surgical interventions are necessary to control the pathological cascade and improve patient outcomes. The objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in adults. Methods This systematic review and meta-analysis compared 190 adult patients with etiologies, signs and symptoms, and surgical outcomes associated with cutaneous manifestations of PF. The PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical interventions, outcomes, and complications were recorded. Results Seventy-nine studies were eligible for the systematic review, and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. A total of 71/190 (38%) cases reported surgical debridement. Fasciotomies were reported in 12/190 (6%) cases and 20 procedures. Amputations were reported in 154/190 (81%) cases. Reconstruction was reported in 45 cases. Skin grafts were applied in 31 cases. Flaps were used for reconstruction in 28 cases. Median (IQR) surgical procedures per patient were 4 (4, 5) procedures. Infectious organisms causing PF were 32% Neisseria meningitidis (n = 55) and 32% Streptococcus pneumonia (n = 55). Coagulase-negative Staphylococcus (95% confidence interval (CI)(8.2–177.9), p = 0.032), Haemophilus influenza (95%CI (7.2–133), p = 0.029), Streptococcus pneumonia (95% CI (13.3–75.9), p = 0.006), and West Nile Virus (95%CI (8.2–177.9), p = 0.032) were associated with significantly more extensive amputations compared to other organisms. Conclusion This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious organism. Neisseria meningitidis and Streptococcus pneumonia were equally the most common organisms associated with PF. The majority of cases were not treated in a burn center. The most common surgeries were amputations, with below-the-knee-amputations being the most common procedure. Skin grafting was the most commonly performed reconstructive procedure. The most common complications were secondary infections. Organisms with significantly more extensive amputations were coagulase-negative Staphylococcus, Haemophilus influenza, Streptococcus pneumonia, and West Nile Virus. Interpretation of findings should be cautioned due to limited sample data.

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Section: Resultsmentioning

confidence: 99%

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

et al. 2019

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“…As the condition progresses, clotting factors and platelets are consumed in widespread intravascular coagulation, which can result in severe bleeding (9). Although bacteria such as Neisseria meningitidis and Streptococcus pneumoniae are the most common microorganisms that cause PF, viruses can rarely cause it (10). Shah et al (11) explained a rare association of purpura fulminans with West Nile Virus infection.…”

Section: Discussionmentioning

confidence: 99%

Association of COVID-19 Infection and Purpura Fulminans

Dashti¹,

Dehghani

Moravej

et al. 2021

Arch Pediatr Infect Dis

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: Coronavirus disease 2019 (COVID-19) was officially declared as a pandemic on March 11, 2020. Although most patients with COVID-19 manifest fever and respiratory tract symptoms, extrapulmonary and atypical presentations, such as gastrointestinal, neurologic, and cardiovascular involvement as well as thromboembolic events have been reported amongst COVID-19 patients. Herein, we aim to describe a COVID-19 patient who progressed to purpura fulminans.

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“…PF is a dramatic and potentially life-threatening manifestation of disseminated intravascular coagulation. The rarity of this hematologic emergency is best illustrated by the fact that only 306 patients were diagnosed with PF in a multicenter retrospective cohort study from France, which included admissions from 55 ICU over the period of 17 years [23]. Furthermore, only 190 adult patients who required surgical intervention for PF were described in a systematic review and meta-analysis of 79 and 77 studies, respectively [24].…”

Section: Discussionmentioning

confidence: 99%

Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review

et al. 2020

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Rare co-existance of disease or pathology Background: Despite proven efficacy of vaccinations against Streptococcus pneumoniae in preventing infection, only 70% of eligible individuals receive the vaccine in the United States. Pneumococcal bacteremia represents a form of invasive pneumococcal disease and is associated with high mortality, especially in immunocompromised patients and the elderly. Purpura fulminans is a rare complication and manifestation of disseminated intravascular coagulation and sepsis. It is exceedingly rare in the setting of pneumococcal bacteremia, particularly in immunocompetent individuals. Case Report: We report a generally healthy 67-year-old male with schizophrenia who refused pneumococcal vaccination. He had an intact and functional spleen with a functional immune system. The patient presented with fever and diarrhea. He subsequently progressed to develop purpura fulminans and septic shock due to S. pneumoniae bacteremia. Despite an extensive search for the primary source of infection, none could not be identified. Due to timely initiation of appropriate antibiotic therapy and aggressive supportive care in an intensive care unit, he recovered despite multi-organ failure that developed throughout his hospitalization. Conclusions: We present a rare manifestation of a potentially preventable disease and emphasize the importance of pneumococcal vaccination in order to decrease the risk of developing invasive pneumococcal disease. Furthermore, we discuss etiology, diagnosis, differential diagnosis, and evidence-based management of purpura fulminans and invasive pneumococcal disease with a literature review. Purpura fulminans due to S. pneumoniae is exceedingly rare in immunocompetent patients and an unusual clinical manifestation of pneumococcal bacteremia.

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Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study

Abstract: NCT03216577.

Cited by 40 publications

References 28 publications

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

Surgical outcomes in adults with purpura fulminans: a systematic review and patient-level meta-synthesis

Association of COVID-19 Infection and Purpura Fulminans

Septic Shock and Purpura Fulminans Due to Streptococcus pneumoniae Bacteremia in an Unvaccinated Immunocompetent Adult: Case Report and Review

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