title: Hyperbaric oxygen: a useful adjunct for purpura fulminans: case report and review of the literature.
abstract: BACKGROUND
  We report a case of a previously healthy adult with flulike symptoms who precipitously declined due to pneumococcal sepsis complicated by disseminated intravascular coagulation (DIC) and purpura fulminans (PF). After one week of care, including ventilation support and hemodialysis, the patient was stable enough for hyperbaric oxygen (HBO2) in an attempt to salvage his threatened extremities. HBO2 resulted in reduction of ischemic tissue and demarcation of blackened tissue to the distal digits. We feel that much at-risk tissue has been spared by HBO2 as an adjunctive therapy.
  
  
  METHODS
  Literature on the use of hyperbaric oxygen for purpura fulminans was reviewed for precipitating issues, time to treatment, protocol, other adjuncts and outcomes.
  
  
  RESULTS
  Fifteen papers were identified representing 19 cases of PF treated with HBO2. No controlled studies exist. HBO2 was believed to be of value in most cases; the improvement was associated with timeliness and aggressiveness of initiating HBO2.
  
  
  CONCLUSIONS
  PF is a fulminant disorder with high mortality and morbidity. Hyperbaric oxygen appears to be useful for the management of PF complications, imposing minimal side effects or complications. Aggressive therapy should be started as soon as it is safe to transfer the patient to a facility for HBO2 treatments.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Cooper
authors.forename: Peter
authors.initials: P
authors.lastname: Allinson
authors.forename: Lon
authors.initials: L
authors.lastname: Keim
authors.forename: Joe
authors.initials: J
authors.lastname: Sisson
authors.forename: Dan
authors.initials: D
authors.lastname: Schuller
authors.forename: Joe
authors.initials: J
authors.lastname: Sippel
authors.forename: David H
authors.initials: DH
authors.lastname: Kovaleski
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications; D055665:Purpura Fulminans / Q000150:complications / Q000473:pathology / Q000628:therapy*; D012141:Respiratory Tract Infections / Q000150:complications; D016896:Treatment Outcome