purpura fulminans: a rare complication may be associated with DIC.
Purpura fulminans is a serious condition often claiming the life of the affected. The detection at an early stage and treatment is of paramount importance. In infants it is associated with protein C and -S deficiency; in idiopathic variety it is associated with functional changed in protein -S. The commonly seen one is post infectious esp. post meningococcal infections. So clinically there will be widespread purpura and ecchymosis, fever, DIC, shock. Where as gangrene is occurring due to an occlusion of a vessel mainly artery. The clinical context will be very different from that of purpura fulminans The affected part will be cold and clammy unless infected, there will be severe pain and limb elevation may sometimes reduce the severity of the pain.
what is the clinical picture of purpura fulminans in adult patient with DIC? could it be below elbow and knee only ?
It can be anywhere and it will fast spread to other areas.
In adults it is the same as in children
Prof Criton
Purpura fulminans (also known as "Purpura gangrenosa is an acute, often fatal, thrombotic disorder which manifests as blood spots, bruising and discolouration of the skin resulting from coagulation in small blood vessels within the skin and rapidly leads to skin necrosis and disseminated intravascular coagulation. Purpura fulminans lesions, once established, often progress within 24 to 48 hours to full-thickness skin necrosis or soft-tissue necrosis. Once purpura fulminans lesions progress to full-thickness skin necrosis, healing takes between 4-8 weeks and leaves large scars. Without treatment, necrotic soft tissue may become gangrenous, leading to loss of limbs.
The cardinal features of purpura investigations are the same as those of disseminated intravascular coagulation: prolonged plasma clotting times, thrombocytopenia, reduced plasma fibrinogen concentration, increased plasma fibrin-degradation products and occasionally microangiopathic haemolysis.
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