Purpura fulminans secondary to rickettsial infections: A case series

Katoch, Saloni; Kallappa, Ravindra; Shamanur, Murugesh; Gandhi, Sneha

doi:10.4103/2229-5178.174324

Cited by 10 publications

(18 citation statements)

References 12 publications

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“…While, in conformity with the previous case series of Gurgey et al . [ 1 ] and Katoch et al .,[ 12 ] a female preponderance was noted in the present series, a male predominance among cases were documented by Davis et al . [ 5 ] and Talwar et al .…”

Section: Discussionsupporting

confidence: 82%

“…[ 1 ] and Katoch et al . [ 12 ] Another noteworthy finding of our study was that 87.5% of the patients who developed peripheral gangrene died and 40% of them had leucopenia with neutropenia. Similar observation was also made by Davis et al .…”

Section: Discussionmentioning

confidence: 65%

“…Several previous studies also showed that infections are the most common cause of purpura fulminans. [ 1 5 12 14 ] Pneumococcus was the most common pathogenic organism detected and was found in 26.1% patients in the present series.…”

Section: Discussionmentioning

confidence: 69%

“…(25%). [ 12 ] On the contrary, a higher rate of peripheral gangrene was seen by Davis et al . (100%),[ 5 ] Parikh et al .…”

Section: Discussionmentioning

confidence: 90%

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A profile of 23 indian patients with purpura fulminans: A retrospective, descriptive study

Ghosh

Bandyopadhyay²,

Dutta

et al. 2020

Indian J Dermatol

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Background: Purpura fulminans (PF) is a potentially fatal uncommon disorder of intravascular thrombosis and is clinically characterized by rapidly progressive hemorrhagic infarction of the skin. Objective: To describe the clinical feature and outcome of a series of patients with PF. Materials and Methods: A descriptive study based on review of case records was carried out at a tertiary care hospital in Kolkata. Results: Twenty three consecutive cases seen over a period of 8 years were studied. The age range was 4 days to 78 years (mean 35.6 years) with a male to female ratio of 1:2.8. Hemorrhagic rash was the universal presenting symptom. Other major presenting features included pneumonia (26.1%), sudden-onset shock syndrome (21.7%), and urinary tract infection (17.4%). All patients presented with retiform purpura and lesional necrosis and 8 (34.8%) patients had associated peripheral gangrene. Nineteen (82.6%) patients had sepsis and 60.9% patients had vesiculo-bullous lesion. Pneumococcus was the most common (26.1%) pathogenic organism detected. The precise cause of PF could not be detected in two (8.7%) patients. One patient (4.3%) with neonatal PF had protein C deficiency. All patients had evidence of disseminated intravascular coagulation (DIC). One patient had to undergo a below knee surgical amputation and one patient had autoamputation of the digits. Ten (43.5%) patients succumbed to their illness. Seven of the 8 patients who had peripheral gangrene had a fatal outcome. Limitations: Relatively small sample size and a referral bias were a few limitations of the present study. Conclusion: The present study emphasizes that PF is a cutaneous marker of DIC. Association of peripheral gangrene, leukopenia and neutropenia may be the reason for the high mortality rate.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 69%

“…(25%). [ 12 ] On the contrary, a higher rate of peripheral gangrene was seen by Davis et al . (100%),[ 5 ] Parikh et al .…”

Section: Discussionmentioning

confidence: 90%

See 2 more Smart Citations

A profile of 23 indian patients with purpura fulminans: A retrospective, descriptive study

Ghosh

Bandyopadhyay²,

Dutta

et al. 2020

Indian J Dermatol

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“…He was treated with replacement of platelets and coagulation factors along with antibiotics and doxycycline, and he made an uneventful recovery [ 15 ]. Katoch et al described a case series of purpura fulminans that included four pediatric patients treated with doxycycline with good recovery [ 16 ]. The few similar cases successfully treated with doxycycline have been reported mainly from the Indian subcontinent [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

Rare presentation of rickettsial infection as purpura fulminans: a case report

Dalugama¹,

Gawarammana²

2018

J Med Case Reports

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BackgroundPurpura fulminans is an acute life-threatening disorder characterized by intravascular thrombosis and hemorrhagic infarction of the skin complicated with disseminated intravascular coagulation. It is commonly seen in acute infections following meningococcal and streptococcal infections. Few cases of purpura fulminans following rickettsial infections have been described in the literature.Case presentationWe report a case of a 55-year-old Sri Lankan woman who presented to Teaching Hospital Peradeniya with a febrile illness, headache, and myalgia that progressed to an erythematous rash starting over the bilateral lover limbs and hands and that became black and necrotic with a few hemorrhagic blebs. She had normocytic anemia, platelet clumps, and monocytosis as well as a deranged clotting profile. The result of immunofluorescence antibody testing for rickettsial immunoglobulin G was strongly positive for Rickettsia conorii with a rise in titer convalescent sera, and a diagnosis of purpura fulminans following rickettsial infection was made. The patient made an excellent recovery with chloramphenicol treatment.ConclusionsThe treating physician should consider the rare but very treatable condition of rickettsial infection as a differential diagnosis in the etiological diagnostic workup of patients presenting with severe purpuric and hemorrhagic rash with fever.

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Purpura fulminans and severe sepsis due toPasteurella multocidainfection in an immunocompetent patient

2016

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A 75-year-old woman was admitted into the intensive care unit, with severe sepsis and renal failure. She developed purpura fulminans (PF) of bilateral upper and lower extremities along with gangrene on the tips of her fingers and toes. Blood cultures confirmed Pasteurella multocida as the causative organism. Despite aggressive supportive measures, the patient remained dependent on high doses of vasopressors and the gangrene progressed. She ultimately succumbed to her underlying severe sepsis. PF is a rare and fatal dermatological emergency commonly seen in children, but it also occurs in adults. Acute infectious PF occurs secondary to severe sepsis and P. multocida is a rare cause of PF. To the best of our knowledge, this is only the second reported case of PF due to P. multocida in an adult.

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Purpura fulminans secondary to rickettsial infections: A case series

Cited by 10 publications

References 12 publications

A profile of 23 indian patients with purpura fulminans: A retrospective, descriptive study

A profile of 23 indian patients with purpura fulminans: A retrospective, descriptive study

Rare presentation of rickettsial infection as purpura fulminans: a case report

Purpura fulminans and severe sepsis due toPasteurella multocidainfection in an immunocompetent patient

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