Purpura fulminans during meningococcal sepsis treated with Drotrecogin alpha. A clinical case.
A male patient, 29 years old, was admitted to our unit with purpura fulminans, coagulation deficiency, renal failure and subsequent septic shock accompanied by respiratory insufficiency in the absence of meningeal signs. The serum levels of endogenous protein C, ATIII and calcium were well below the norm. The bacteriological examination revealed the presence of gram-negative diplococci. The onset of adult respiratory distress syndrome (ARDS) revealed aa early complication of the meningococcal sepsis. Forty-eight hours after being admitted, the recombinant protein C infusion was started at a dose of 24 microg/kg/h for the duration of 96 h. The skin lesions regressed, starting from the ecchymosis and the edema of the face, trunk and auricular pavilions. A week after the onset of the symptomatology the chest X-ray appeared clear, the renal function had normalised, and the signs of shock had disappeared.
Belloni
G
G
Anesthesia and Intensive Care Unit, City Hospital, Ivrea, Italy. rianimazione@asl.ivrea.to.it
Ramello
P
P
Salcuni
M R
MR
Scavone
L
L
Girotto
M
M
Di Bassiano
F
F
D000328:Adult; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D009345:Neisseria meningitidis; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000150:complications*
D005343:Fibrinolytic Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated