Purpura fulminans in a child as a complication of chickenpox infection.
Purpura fulminans is a thrombotic disease that can occur during infections, disseminated intravascular coagulation or in the context of an acquired or congenital protein C or S deficiency. Here we report the case of a 4-year-old child who developed, 5 days after a chickenpox infection, large painful ecchymotic, necrotizing and retiform plaques on the lower extremities. Laboratory analyses revealed very low protein S levels as well as anticardiolipin antibodies. Aggressive treatment by low-molecular-weight heparin, steroids, intravenous immunoglobulins and fresh frozen plasma was able to prevent the extension of the lesions and to correct the coagulation abnormalities. No lesions required skin grafting. As in our patient, an acquired protein S deficiency is probably responsible for most cases of purpura fulminans occurring after varicella, but the concomitant presence of antiphospholipid antibodies may also play a role.
Campanelli
Alexandre
A
Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland. alexandre.campanelli@hcuge.ch
Kaya
Gürkan
G
Ozsahin
Ayse Hulya
AH
La Scala
Giorgio
G
Jacquier
Cédric
C
Stauffer
Mélanie
M
Boehlen
Françoise
F
de Moerloose
Philippe
P
Saurat
Jean-Hilaire
JH
D017153:Antibodies, Anticardiolipin / Q000097:blood; D002644:Chickenpox / Q000150:complications*; D002675:Child, Preschool; D006801:Humans; D011695:IgA Vasculitis / Q000473:pathology* / Q000821:virology*; D035002:Lower Extremity; D008297:Male; D009336:Necrosis; D018455:Protein S Deficiency / Q000150:complications
D017153:Antibodies, Anticardiolipin