|Classification and external resources|
|ICD-10||D65 (ILDS D65.x20)|
Purpura fulminans (also known as "Purpura gangrenosa":825) is a haemorrhagic condition usually associated with sepsis or previous infection, it is the cutaneous manifestation of disseminated intravascular coagulation. Occurs mainly in babies and small children, but there are also rare cases reported among adults.
Common causes are severe infection (especially with meningococcus, and Capnocytophaga canimorsus, and other Gram-negative organisms), and deficiency of the natural anticoagulants protein C or protein S in the blood. In some cases, a cause is never found.
Treatment is mainly by removing the underlying cause and degree of clotting abnormalities and with supportive treatment (antibiotics, volume expansion, tissue oxygenation, etc.). Thus, treatment includes aggressive management of the septic state. Surgical debridement, escharotomies, fasciotomies, and even amputations. In many cases, digits may need to be amputated when their blood supply has ceased completely. The use of full dose heparin or other anticoagulant is controversial.
It is often difficult to determine tissue viability during the resuscitation phase and debridement and amputation should therefore ideally be deferred until demarcation has taken place.
It was first described by Guelliot in 1884.
- James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- Murray, Patrick R.; Rosenthal, Ken S.; Pfaller, Michael A. (2009) Medical Microbiology. Mosby Elsevier. Chapter 21 "staphylococcus and other related gram-positive cocci" page 218
- Nolan J, Sinclair R (2001). "Review of management of purpura fulminans and two case reports". British journal of anaesthesia 86 (4): 581–6. doi:10.1093/bja/86.4.581. PMID 11573639.
- Marciniak E, Wilson HD, Marlar RA (1985). "Neonatal purpura fulminans: a genetic disorder related to the absence of protein C in blood". Blood 65 (1): 15–20. PMID 3838081.
- Guelliot A (1884). "Note sur trois cas de purpusa infectieux foudroyant". Un Med Sci Nord-Est 8: 25.