SURVIVAL CASE OF PURPURA FULMINANS IN MENINGOCOCCAL SEPTICAEMIA IN AN ADULT WITH TRANSIENT PROTEIN C DEFICIENCY: A CASE REPORT

Abstract

ABSTRACT Background: Purpura fulminans (PF) is a rapidly progressive thrombotic disorder affecting neonates and children and adults in which there is haemorrhagic infarction of skin and disseminated intravascular coagulation. Gram-negative organisms especially due to Neisseria meningitides are certainly the commonest hematogenous infection known to induce PF and the commonest cause of the acute infection type. Objectives: We report a case of a survival case of a patient with purpura fulminas associated with meningococcal septicemia in an adult with transient protein deficit C deficit. In addition we review the etiology, clinical features and current treatment. Case Report: A 19-year-old woman was admitted to the emergency department because of oliguria, fever, and a diffuse rash. Her skin examination showed a diffuse, palpable purpuric rash consistent with purpura fulminans. Hypoxic respiratory failure with the development of acute respiratory distress syndrome and anuric renal failure quickly developed. Laboratory tests revealed disseminated intravascular coagulation she also had clinical findings of the Waterhouse–Friderichsen syndrome. The clinical course was complicated with acute tubular necrosis and Klebsiella pneumonia. The bronchoalveolar lavage gram stain and culture grew Gram-negative diplococci. Transient deficiency of protein S was observed and normalized after 10 days. After treatment in the Intensive Care Unit the patient’s evolution was favorable and she was discharged from hospital at 32 days after admission. Conclusions Purpura fulminans associated with meningococcemia is a devastating but rare disease with high mortality. Early diagnosis and proper treatment is necessary to prevent death from this otherwise fatal condition

Keywords

• MENINGOCOCCAL
• SEPTICEMIA
• PURPURA FULMINAS
• PROTEIN C DEFICIENCY
• WATERHOUSE-FRIERICHSEN SYNDROME.