a)   What  lesion  is shown  in the  picture  below  in  a patient  presenting  with septic shock?

b)   List 5 other causes of this lesion

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College Answer

a)   What  lesion  is shown  in the  picture  below  in  a patient  presenting  with septic shock?

Purpura fulminans

b)   List 5 other causes of this lesion

•   Meningococcemia 
•  Post-splenectomy pneumococcemia
•   DIC 
•  Rickettsial infections
•  High dose inotropes
•   Endocarditis

A clinical photograph of purpura fulminans was supplied.

Discussion

This photograph of purpura fulminans was acquired legally (according to usage rights) fromwww.unboundedmedicine.com to whom I am grateful. The specific image is of a child suffering from menigococcal sepsis.

An excellent review presents a breakdown of the differential causes of puprura fulminans, which include the following:

  • DIC from any cause
  • Sepsis due to the following organisms:
  • MAHA (microangiopathic haemolytic anaemia)
  • TTP (thrombotic thrombocytopenic purpura)
  • Varicella infection
  • Rickettsial infection
  • Plasmodium falciparum malaria
  • Vasopressor excess
  • Warfarin-induced skin necrosis
  • Congenital Protein C anticoagulant pathway defect
  • Post-infectious purpura fulminans (due to autoimmune destruction of proteins C or S)

References

Gürses, Nuran, and Ismail Ilek. "Causes of purpura fulminans." The Pediatric infectious disease journal 14.6 (1995): 552.

 

Spicer, Thomas E., and Jerold M. Rau. "Purpura fulminans." The American journal of medicine 61.4 (1976): 566-571.

 

Chalmers, E., et al. "Purpura fulminans: recognition, diagnosis and management." Archives of disease in childhood 96.11 (2011): 1066-1071.