Purpura fulminans: a case series managed at a regional burn center.
Purpura fulminans (PF) is a protein C deficiency disease process with a high case fatality rate; however, overall incidence of the disease remains relatively very low. The similarity between skin necrosis secondary to PF and full-thickness skin burns provides the rationale for treating PF case in a burn center. In this case series we reviewed our experiences in managing PF and their associated favorable outcomes. Retrospective chart review of five PF cases managed between September 2004 and August 2006 at our Burn Center with 100% survival. Management of cases following the standard care of the Burn Center for a full-thickness burn included antibiotics, fluid resuscitation, surgical debridement with skin grafting, and activated protein C (Drotrecogin alfa) replacement. Two patients required amputations of extremities and all had surgical debridement. One required hemodialysis and two needed both hemodialysis and positive-pressure mechanical ventilator. No patient experienced any bleeding complications during or after surgery while receiving activated protein C. Early diagnosis and treatment at a burn center may reduce mortality and morbidity and loss of extremities in PF cases.
Hassan
Zaheed
Z
Joseph M Still Burn Center Inc, Joseph M Still Burn Center, Doctors Hospital, Augusta, GA, USA.
Mullins
Robert F
RF
Friedman
Bruce C
BC
Shaver
Joseph R
JR
Alam
Badrul
B
Mian
Mohammad A H
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002053:Burn Units; D003646:Debridement / Q000379:methods*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated