Lower limb necrosis secondary to purpura fulminans: A case report


 Purpura fulminans is a rare and rapidly progressive septic process characterized by the development of hemorrhagic and ecchymotic lesions and skin necrosis. In this work, we report a case of a 52-year-old woman admitted to the Department of Emergency due to progressive purpura. The physical examination demonstrated a decreased skin temperature, unpalpable dorsalis pedis arteries and ecchymoses covering both lower extremities. Laboratory tests indicated DIC with prolonged aPTT, low PT, elevated D-dimer levels and a low platelet count. A diagnosis of purpura fulminans was made, and steroids, therapeutic plasma exchange (TPE) and empiric therapy, including antibiotic and anticoagulation therapy, were initiated immediately. Our treatment resulted in a good and sustained clinical response, as evidenced by the receding of blood blisters and the normalization of the patient’s coagulation factors, but bilateral below-knee amputation was inevitable. Finally, the patient recovered well and was discharged home without any complications other than amputation.