Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic.
BACKGROUND
Dermatologists may be called to assist in the diagnosis and management of purpura fulminans.


METHODS
This retrospective case series details the clinical presentation and outcomes of patients presenting with purpura fulminans associated with peripheral gangrene between 1989 and 2004.


RESULTS
All 12 patients presented with sudden onset of purpuric patches and evolving gangrene of the extremities in association with a shock syndrome (hypotension, oliguria). Eleven patients had disseminated intravascular coagulation. The cause of purpura fulminans was infectious in 9 patients, surgical in two, and cancer in one. Three patients died (25%) within a week of onset of purpura fulminans. Of the 9 surviving patients, 8 required amputation of at least one limb. Four patients required amputation of all 4 limbs.


CONCLUSIONS
Retrospective study design, varying clinical descriptions, and potential referral bias are limitations.


CONCLUSIONS
Purpura fulminans in association with symmetric peripheral gangrene is an ominous clinical presentation.
Davis
Mark D P
MD
Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA. davis.mark2@mayo.edu
Dy
Katrina M
KM
Nelson
Steven
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005734:Gangrene / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D066298:In Vitro Techniques; D008875:Middle Aged; D012189:Retrospective Studies