title: Adult purpura fulminans associated with staphylococcal infection and administration of colony-stimulating factors.
abstract: Purpura fulminans (PF) is a rare syndrome of progressive haemorragic necrosis due to disseminated intravascular coagulation (DIC) and dermal vascular thrombosis leading to purpura and tissue necrosis. PF is more often associated with either a benign infection or a severe sepsis. Rarely, it has been related to drug intake. We report the case of a 24-year-old female patient who suffered from staphylococcal sepsis and pancytopenia, for which she was treated with antibiotics, granulocyte-colony stimulating factor (G-CSF) and granulocyte/macrophage CSF (GM-CSF). Two days after the last GM-CSF dose, she developed widespread necrotic plaques with erythematous borders and purpura in the breast, arms and legs. Coagulation tests indicated DIC and a skin biopsy showed fibrin thrombi in the superficial dermal vessels. The patient totally recovered after removal of the necrotic tissues and application of skin autografts. Although staphylococcal infection was most probably involved in the development of PF, a role of CSF cannot be excluded in this case.
authors.affiliation: Hospital Italiano, Department of Dermatology, Zapiola 748 (1426), Buenos Aires, Argentina. gaston.galimberti@hospitalitaliano.org.ar
authors.forename: Ricardo
authors.initials: R
authors.lastname: Galimberti
authors.forename: Nelida
authors.initials: N
authors.lastname: Pietropaolo
authors.forename: Gaston
authors.initials: G
authors.lastname: Galimberti
authors.forename: Alicia
authors.initials: A
authors.lastname: Kowalczuk
mesh_terms: D000328:Adult; D003115:Colony-Stimulating Factors / Q000009:adverse effects* / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000139:chemically induced / Q000209:etiology* / Q000473:pathology; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy; D012867:Skin / Q000473:pathology; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy
chemical_list: D003115:Colony-Stimulating Factors