Evolution of purpura fulminans

Excerpt

A 20-year-old woman with no comorbid condition was admitted to the intensive care unit (ICU) for an acute circulatory failure with a purpuric rash on the trunk and the face (Fig. 1). Biological exams revealed hyperlactatemia with acute kidney failure and disseminated intravascular coagulation. The patient was immediately treated with intravenous ceftriaxone, hydrocortisone and norepinephrine. Culture of skin biopsy grew Neisseria meningitidis serogroup Y at day 2, confirming the diagnosis of meningococcal purpura fulminans. The patient evolved well and was discharged alive from the ICU at day 6. The figure depicts the course of a typical purpuric rash of the face from day 1 (ICU admission) to day 14. Initially ecchymotic at ICU admission, the rash evolved towards superficial skin necrosis at day 3, with healing starting from day 7 until quasi-total recovery at day 14. Although sometimes devastating, skin rash of purpura fulminans may rapidly evolve without major ischemic cutaneous sequelae.

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