Unbounded Medicine

Purpura fulminans

It is a severe condition due to meningococcal sepsis, it occurs in 15 to 25% of those patients with meningococcemia.

The clinical picture is as follows: acute onset of cutaneous hemorrhage and necrosis secondary to vascular thrombosis and disseminated intravascular coagulation. Often there is pain followed by petechiae. Ecchymoses develop and evolve into painful indurated, well-demarcated purple papules with erythematous borders (as you can see in the image this lesions are coalescent). Then this lesions progress to necrosis with formation of bullae and vesicles. Gangrenous necrosis can follow with extension into the subcutaneous tissue and occasionally involves muscle and bone.

To prevent this complication of meningococcemia you have to be prompt and agressive with IV antibiotics and support of vascular perfusion. The use of Xigris (drotrecogin alfa activated) have shown promising results once the process has instaled. Often this patients require surgical debridement, skin grafting or limb amputation.

Regards,

Jon Mikel Iñarritu, M.D.