Purpura fulminans: Difference between revisions
ClaireLewis (talk | contribs) (Created page with "==Background== *Life-threatening syndrome of intravascular coagulation and hemmorrhagic skin infarction--> DIC and vascular collapse *Usually occurs in children, but can o...") |
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*Most commonly in the setting of overwhelming sepsis OR 7-10 days after infection | *Most commonly in the setting of overwhelming sepsis OR 7-10 days after infection | ||
*Causes: | *Causes: | ||
**Meningococcus | **[[Meningococcus]] | ||
** | **[[Streptococcus]] species | ||
**Varicella | **[[Varicella]] | ||
** | **[[Rickettsia sp]] | ||
**Venom-induced consumptive coagulopathy (VICC) due to | **Venom-induced consumptive coagulopathy (VICC) due to [[snake bites]] | ||
**Protein C, protein S, or antithrombin III deficiency | **Protein C, protein S, or antithrombin III deficiency | ||
**Drug-induced | |||
==Clinical Features== | ==Clinical Features== | ||
*Erythematous macules rapidly progress--> Large, purpuric lesions | *Erythematous macules rapidly progress--> Large, purpuric lesions | ||
| Line 15: | Line 16: | ||
*[[Hypotension]] | *[[Hypotension]] | ||
*[[Fever]] | *[[Fever]] | ||
[[File:Baby_purpura.png|thumb|Neonatal purpura fulminans]] | |||
[[File:PurpuraFulminans.png|thumb|]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 23: | Line 26: | ||
*Infectious work up | *Infectious work up | ||
==Management== | ==Management== | ||
*Treat shock | *Treat [[shock]] | ||
*Treat underlying infection | *Treat underlying infection | ||
*Necrotic tissue may require debridement | *Necrotic tissue may require debridement | ||
*Coagulopathy correction, in some cases | *Coagulopathy correction, in some cases | ||
**Typically only if bleeding or need for procedure | **Typically only if bleeding or need for procedure | ||
***Exception: FFP usually indicated for neonatal purpura fulminans | ***Exception: [[FFP]] usually indicated for neonatal purpura fulminans | ||
** | **[[Cryoprecipitate]]: consider if fibrinogen <100 | ||
**Platelets: consider repletion if <50K with bleeding or <20K without bleeding | **[[Platelets]]: consider repletion if <50K with bleeding or <20K without bleeding | ||
**FFP: consider repletion to goal of PT and PTT < 1.5 times the normal limit | **[[FFP]]: consider repletion to goal of PT and PTT < 1.5 times the normal limit | ||
**Vitamin K, folate | **[[Vitamin K]], folate | ||
==Disposition== | ==Disposition== | ||
*Admit! | *Admit! | ||
Revision as of 20:36, 10 August 2016
Background
- Life-threatening syndrome of intravascular coagulation and hemmorrhagic skin infarction--> DIC and vascular collapse
- Usually occurs in children, but can occur in adults
- Most commonly in the setting of overwhelming sepsis OR 7-10 days after infection
- Causes:
- Meningococcus
- Streptococcus species
- Varicella
- Rickettsia sp
- Venom-induced consumptive coagulopathy (VICC) due to snake bites
- Protein C, protein S, or antithrombin III deficiency
- Drug-induced
Clinical Features
- Erythematous macules rapidly progress--> Large, purpuric lesions
- DIC
- Hypotension
- Fever
Differential Diagnosis
Evaluation
- DIC work up
- CBC, PT/PTT, fibrinogen, d-dimer, FDP
- Infectious work up
Management
- Treat shock
- Treat underlying infection
- Necrotic tissue may require debridement
- Coagulopathy correction, in some cases
- Typically only if bleeding or need for procedure
- Exception: FFP usually indicated for neonatal purpura fulminans
- Cryoprecipitate: consider if fibrinogen <100
- Platelets: consider repletion if <50K with bleeding or <20K without bleeding
- FFP: consider repletion to goal of PT and PTT < 1.5 times the normal limit
- Vitamin K, folate
- Typically only if bleeding or need for procedure
Disposition
- Admit!