Purpura fulminans: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Life-threatening syndrome of intravascular coagulation and hemmorrhagic skin | *Life-threatening syndrome of intravascular coagulation and hemmorrhagic skin infarction→ [[DIC]] and vascular collapse | ||
*Usually occurs in children, but can occur in adults | *Usually occurs in children, but can occur in adults | ||
*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=== | ||
| Line 14: | Line 14: | ||
==Clinical Features== | ==Clinical Features== | ||
*Erythematous macules rapidly | [[File:Baby_purpura.png|thumb|Neonatal purpura fulminans]] | ||
[[File:PurpuraFulminans.png|thumb|Purpura fulminans]] | |||
*Erythematous [[rash|macules]] rapidly progress→ Large, purpuric lesions | |||
*[[DIC]] | *[[DIC]] | ||
*[[Hypotension]] | *[[Hypotension]] | ||
*[[Fever]] | *[[Fever]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 33: | Line 33: | ||
*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 | ||
| Line 39: | Line 39: | ||
**[[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! | ||
Latest revision as of 22:46, 9 September 2020
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
Petechiae/Purpura (by findings)
- Febrile, toxic
- Palpable
- Meningococcemia
- Disseminated gonococcal infection
- Endocarditis
- Rocky mountain spotted fever
- HSP
- Non-palpable
- Palpable
- Afebrile, nontoxic
- Palpable
- Autoimmune vasculitis
- Non-palpable
- Palpable
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!