American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2020, 8(11), 421-423
DOI: 10.12691/ajmcr-8-11-11
Open AccessCase Report

Acute Infectious Purpura Fulminans Complicated with Multiple Erosions

Saya Ikegami1, Kei Jitsuiki1, Ken-ichi Muramatsu1, Hiroki Nagasawa1, Ikuto Takeuchi1 and Youichi Yanagawa1,

1Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University

Pub. Date: July 30, 2020

Cite this paper:
Saya Ikegami, Kei Jitsuiki, Ken-ichi Muramatsu, Hiroki Nagasawa, Ikuto Takeuchi and Youichi Yanagawa. Acute Infectious Purpura Fulminans Complicated with Multiple Erosions. American Journal of Medical Case Reports. 2020; 8(11):421-423. doi: 10.12691/ajmcr-8-11-11

Abstract

An 80-year-old man was extremely skinny and developed a left leg phlegmon. He was admitted and underwent an infusion of cefazolin. On the third day, he suddenly collapsed, and advanced cardiac life support resulted in a return of his circulation. He showed vasopressor-resistant hypotension and therefore received an infusion of steroids and multiple supportive therapies. A blood culture later showed Pseudomonas aeruginosa. While his blood pressure increased, he showed peripheral and labile cyanotic changes, even though his peripheral arteries were palpable. On the third day after the collapse, he showed blisters at purpura sites and labile, resulting in the formation of erosions. On the fourth day, massive effusion was drained from the erosive lesions. He temporarily showed a return of consciousness, but his extremities became necrotic, and he ultimately died due to a secondary infection at the erosive lesions. The present fatal case of acute infectious purpura fulminans might have been induced by a P. aeruginosa infection due to complications with multiple blisters, similar to Stevens-Johnson syndrome/toxic epidermal necrolysis. Early aggressive surgical amputation or debridement might be required to obtain a survival outcome when encountering such cases.

Keywords:
purpura fulminans Pseudomonas aeruginosa toxic epidermal necrolysis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Childers, B.J. and Cobanov, B. “Acute infectious purpura fulminans: a 15-year retrospective review of 28 consecutive cases”. Am Surg, 69(1), 86-90, Jan 2003.
 
[2]  Contou, D., Sonneville, R., Canoui-Poitrine, F., Colin, G., Coudroy, R., Pène, F., Tadié, J.M., Cour, M., Béduneau, G., Marchalot, A., Guérin, L., Jochmans, S., Ehrmann, S., Terzi, N., Préau, S., Barbier, F., Schnell, G., Roux, D., Leroy, O., Pichereau, C., Gélisse, E., Zafrani, L., Layese, R., Brun-Buisson, C., Mekontso Dessap, A. and de Prost, N. “Hopeful Study Group. Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study”. Intensive Care Med, 44(9), 1502-1511, Sep 2018.
 
[3]  Childers, B.J. and Cobanov, B. “Acute infectious purpura fulminans: a 15-year retrospective review of 28 consecutive cases”. Am Surg, 69(1), 86-90, Jan 2003.
 
[4]  Hasegawa, A. and Abe, R. “Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis.” F1000Res, 9, F1000 Faculty Rev-612, Jun 2020.
 
[5]  Dautzenberg, K.H.W., Polderman, F.N., van Suylen, R.J. and Moviat, M.A.M. “Purpura fulminans mimicking toxic epidermal necrolysis - additional value of 16S rRNA sequencing and skin biopsy”. Neth J Med, 75(4), 165-168, May 2017.
 
[6]  Jones, E., Stair-Buchmann, M., Kotliar, S. and Haith, L. “Purpura fulminans in toxic epidermal necrolysis: case report and review”. J Burn Care Res, 36(6), e274-82, 2015.
 
[7]  Lerolle, N., Carlotti, A., Melican, K., Aubey, F., Pierrot, M., Diehl, J.L., Caille, V., Hékimian, G., Gandrille, S., Mandet, C., Bruneval, P., Dumenil, G. and Borgel, D. “Assessment of the interplay between blood and skin vascular abnormalities in adult purpura fulminans”. Am J Respir Crit Care Med, 188(6), 684-92, Sep 2013.
 
[8]  Aroor, S., Varma, C. and Mundkur, S.C. “Purpura fulminans in a child: a case report”. J Clin Diagn Res, 6(10), 1812-3, Dec 2012.
 
[9]  Chakhtoura, N.G.E., Bonomo, R.A. and Jump, R.L.P. “Influence of Aging and environment on presentation of infection in older adults”. Infect Dis Clin North Am, 31(4), 593-608, Dec 2017.
 
[10]  Winter-Jensen, M., Afzal, S., Jess, T., Nordestgaard, B.G. and Allin, K.H. “Body mass index and risk of infections: a Mendelian randomization study of 101,447 individuals”. Eur J Epidemiol, 35(4), 347-354, Apr 2020.
 
[11]  Cooper, M.S. and Stewart, P.M. “Adrenal Insufficiency in Critical Illness”. J Intensive Care Med, 22(6), 348-62, Nov-Dec 2007
 
[12]  Tormos, L.M. and Schandl, C.A. “The significance of adrenal hemorrhage: undiagnosed Waterhouse-Friderichsen syndrome, a case series”. J Forensic Sci, 58(4), 1071-4, Jul 2013.
 
[13]  Chan, J.C.Y., Chiu,. ML.S., Yeung, C.K., Yuen, K.Y. and Chan, H.H.L. “A unique pattern of Staphylococcal scalded skin syndrome-like erosions in patients with atopic dermatitis: dermatitis flammeus”. Skinmed. 16(5), 309-313, Nov 2018.
 
[14]  Mazzone, L. and Schiestl, C. “Management of septic skin necroses”. Eur J Pediatr Surg, 23(5), 349-58, Oct 2013.
 
[15]  Gunawardane, N.D., Menon, K., Guitart, J. and Cotliar, J.A. “Purpura fulminans from Meningococcemia mimicking Stevens-Johnson syndrome in an adult patient taking etanercept”. Arch Dermatol. 148(12), 1429-31, Dec 2012.