title: Purpura fulminans in a child as a complication of chickenpox infection.
abstract: 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.
authors.affiliation: Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland. alexandre.campanelli@hcuge.ch
authors.forename: Alexandre
authors.initials: A
authors.lastname: Campanelli
authors.forename: Gürkan
authors.initials: G
authors.lastname: Kaya
authors.forename: Ayse Hulya
authors.initials: AH
authors.lastname: Ozsahin
authors.forename: Giorgio
authors.initials: G
authors.lastname: La Scala
authors.forename: Cédric
authors.initials: C
authors.lastname: Jacquier
authors.forename: Mélanie
authors.initials: M
authors.lastname: Stauffer
authors.forename: Françoise
authors.initials: F
authors.lastname: Boehlen
authors.forename: Philippe
authors.initials: P
authors.lastname: de Moerloose
authors.forename: Jean-Hilaire
authors.initials: JH
authors.lastname: Saurat
mesh_terms: 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
chemical_list: D017153:Antibodies, Anticardiolipin