Purpura fulminans. A cutaneous manifestation of severe protein C deficiency.
Protein C, when activated, is a vitamin K-dependent serine protease that has anticoagulant and profibrinolytic activities. An increased risk of thrombotic disease is associated with deficiency of this enzyme. A neonate developing purpura fulminans with internal thrombotic complications and congenital absence of protein C is described. Family studies showed partial protein C deficiency in the subject's symptom-free parents and two of three siblings. Clinically and histopathologically similar lesions are also seen in two acquired conditions in which there is a thrombotic tendency: coumarin necrosis and purpura fulminans of childhood, both of which are probably the result of transient protein C deficiency. We conclude that purpura fulminans can represent a cutaneous marker of acquired or congenital protein C deficiency.
Auletta
M J
MJ
Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109-0602.
Headington
J T
JT
D001706:Biopsy; D001777:Blood Coagulation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009336:Necrosis; D020151:Protein C Deficiency; D011693:Purpura / Q000097:blood / Q000209:etiology* / Q000473:pathology; D012867:Skin / Q000473:pathology