Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic

Davis, Mark D.P.; Dy, Katrina M.; Nelson, Sara

doi:10.1016/j.jaad.2007.07.039

Cited by 98 publications

(119 citation statements)

References 39 publications

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“…Recent reviews by the experts in the UK 14 and North America 15 described only eight and 12 survivors with long-term therapy, respectively. The nationwide survey of pediatric thrombosis in Japan first collected 301 patients from 2006 to 2010.…”

Section: Genetic Backgrounds Of Pc Deficiency In Japanmentioning

confidence: 99%

Protein C deficiency as the major cause of thrombophilias in childhood

Ohga

Ishiguro

Takahashi

et al. 2013

Pediatrics International

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Section: Genetic Backgrounds Of Pc Deficiency In Japanmentioning

confidence: 99%

Protein C deficiency as the major cause of thrombophilias in childhood

Ohga

Ishiguro

Takahashi

et al. 2013

Pediatrics International

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“…Symmetrical peripheral gangrene carries a mortality rate as high as 35% to 40% and an equally high morbidity rate; the literature reports an amputation rate upwards of 70%. 8,9 Suggested first-line measures when identified early include discontinuation of vasopressors, reversal of DIC by cautious anticoagulation, and aggressive treatment of shock and sepsis. Adjuvant therapy with tissue plasminogen activator, plasmapheresis, sympathetic blockade, and aspirin has been recognized to contribute to favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

Symmetrical Peripheral Gangrene

2006

IJS

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DESCRIPTIONA 27-year-old woman presented to the clinic with well-demarcated symmetrical dry gangrene of all the toes. The onset was insidious during recent hospitalization for urosepsis and shock. There is no antecedent history of peripheral ischemia, use of oral contraceptive pill, or smoking. Her medical history is significant for hypertension and preeclampsia. Dorsalis pedis and posterior tibial pulses were palpable.NEXT

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“…Eight of the 9 survivors required amputation of at least 1 limb, and 4 of them required 4-limb amputation. 7 In this patient who presented with fever and rash, the discussant recognized early on an underlying infectious etiology. Although the patient's exposure history led the discussant to consider a host of possibilities, the recognition of purpura fulminans allowed him to narrow his differential.…”

mentioning

confidence: 93%

The hand that feeds you

Pierce

Sharpe

Hansra

et al. 2012

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. A 66-year-old man presented to the Emergency Department (ED) with rash and malaise in early April. He was in his usual state of good health until the morning of presentation, when he awoke feeling lethargic. Over the course of the day, his hands and feet grew cold and numb, his nose became dark red, and he developed a diffuse, net-like red rash over his legs, hands, buttocks, and trunk. He had multiple maroon bowel movements. His wife noted that he became ''incoherent'' and brought him to the ED.This apparently previously healthy man presented with an acute episode of fatigue and altered mental status accompanied by a prominent cutaneous eruption. The differential diagnosis will ultimately be guided by the morphology of the rash. At this stage, infectious diseases, drug or toxin exposure, and allergic processes including anaphylaxis must all be considered in this patient with rash and acute illness. The maroon bowel movements likely represent a gastrointestinal bleed that may be part of a unifying diagnosis-a hematologic disorder, a vasculitis, or liver disease.In the ED, the patient was reportedly febrile (exact temperature not recorded) with a blood pressure of 96/54 mmHg. He had pulse oximetry of 88% on room air and a diffuse purpuric rash. The patient was noted to have a leukocytosis, thrombocytopenia, coagulopathy, and an elevation of his creatinine and cardiac enzymes. He was given fluids, fresh frozen plasma, and broad-spectrum antibiotics, and transferred directly to the intensive care unit of a tertiary medical center for further management.Upon arrival to the intensive care unit, he complained of fatigue, progression of his nonpruritic, nonpainful rash, and worsening numbness and tingling of his extremities. He denied headache, nuchal rigidity, photophobia, vision or hearing changes, chest pain, cough, abdominal pain, myalgias, or arthralgias. While being interviewed, he had dark brown emesis and a bloody bowel movement.The patient's past medical history included bacterial pericarditis as a teenager and remote hepatitis of unclear etiology. He rarely saw a physician, took no medications, and had no known medication allergies.

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Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic

Cited by 98 publications

References 39 publications

Protein C deficiency as the major cause of thrombophilias in childhood

Protein C deficiency as the major cause of thrombophilias in childhood

Symmetrical Peripheral Gangrene

The hand that feeds you

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