Purpura fulminans is a hemorrhagic condition associated predominantly with meningococcal and other gram negative septicemias. It occurs mainly in infants and younger children. Features include tissue necrosis, small v...Purpura fulminans is a hemorrhagic condition associated predominantly with meningococcal and other gram negative septicemias. It occurs mainly in infants and younger children. Features include tissue necrosis, small vessel thrombosis, disseminated intravascular coagulation, multi-organ failure and death. Other causes include clotting factor deficiencies and idiopathic varieties. The condition is uncommon due to gram positive bacterial sepsis. We report one such case with gram positive bacterial infection.展开更多
An 18-year-old man had numerous multiple painful nodulocystic lesions, pustules, and necrotic hemorrhagic ulcerative lesions with crusts on the face, back, chest and upper arm two weeks ago. Systemic symptoms such as ...An 18-year-old man had numerous multiple painful nodulocystic lesions, pustules, and necrotic hemorrhagic ulcerative lesions with crusts on the face, back, chest and upper arm two weeks ago. Systemic symptoms such as fever, general fatigue and arthralgia were not observed. Laboratory findings revealed an elevated white blood cell count with a neutrophilia and C-reactive protein. Oral antimicrobials did not respond. Consequently, oral prednisolone (20 mg/d) for two weeks induced remarkable improvement promptly. A case of acne fulminans without systemic symptoms successfully treated with oral corticosteroids has been reported.展开更多
Background:Purpura fulminans(PF),characterized by the sudden onset of large,rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation,is an uncommon medical emergency.Early r...Background:Purpura fulminans(PF),characterized by the sudden onset of large,rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation,is an uncommon medical emergency.Early recognition,prompt antibiotic therapy,and intensive supportive care are essential to reduce the mortality rate of this disease.Case Presentation:We report the case of a 28-year-old Chinese man with acute infectious PF.He initially presented with a fever,which rapidly progressed to septic shock,followed by skin lesions and disseminated intravascular coagulation.Computed tomography imaging revealed superior and inferior mesenteric vein thromboses.Although the etiology of the patient’s infection was unclear,the patient received early fluid resuscitation,empiric antibiotic therapy,and blood product replacement,which resulted in gradual clinical improvement.Conclusion:Sepsis-associated PF may be reversible with timely empirical therapeutic interventions;however,the severity of PF should not be underestimated,and treatment should be tailored to individual patients.展开更多
Background:Cutaneous manifestations of purpura fulminans(PF)present many challenges for clinicians and surgeons.In a state of septic shock complicated by limb ischemia,surgical interventions are necessary to control t...Background:Cutaneous manifestations of purpura fulminans(PF)present many challenges for clinicians and surgeons.In a state of septic shock complicated by limb ischemia,surgical interventions are necessary to control the pathological cascade and improve patient outcomes.The objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in adults.Methods:This systematic review and meta-analysis compared 190 adult patients with etiologies,signs and symptoms,and surgical outcomes associated with cutaneous manifestations of PF.The PubMed,EMBASE,Cochrane Library,Web of Science,and Scopus databases were systematically and independently searched.Patient and clinical characteristics,surgical interventions,outcomes,and complications were recorded.Results:Seventy-nine studies were eligible for the systematic review,and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)and Cochrane guidelines.A total of 71/190(38%)cases reported surgical debridement.Fasciotomies were reported in 12/190(6%)cases and 20 procedures.Amputations were reported in 154/190(81%)cases.Reconstruction was reported in 45 cases.Skin grafts were applied in 31 cases.Flaps were used for reconstruction in 28 cases.Median(IQR)surgical procedures per patient were 4(4,5)procedures.Infectious organisms causing PF were 32%Neisseria meningitidis(n=55)and 32%Streptococcus pneumonia(n=55).Coagulase-negative Staphylococcus(95%confidence interval(CI)(8.2–177.9),p=0.032),Haemophilus influenza(95%CI(7.2–133),p=0.029),Streptococcus pneumonia(95%CI(13.3–75.9),p=0.006),and West Nile Virus(95%CI(8.2–177.9),p=0.032)were associated with significantly more extensive amputations compared to other organisms.Conclusion:This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious organism.Neisseria meningitidis and Streptococcus pneumonia were equally the most common organisms associated with PF.The majority of cases were not treated in a burn center.The most common surgeries were amputations,with below-the-knee-amputations being the most common procedure.Skin grafting was the most commonly performed reconstructive procedure.The most common complications were secondary infections.Organisms with significantly more extensive amputations were coagulase-negative Staphylococcus,Haemophilus influenza,Streptococcus pneumonia,and West Nile Virus.Interpretation of findings should be cautioned due to limited sample data.展开更多
BACKGROUND Case reports of symmetric digital gangrene resulting from high-dose vasopressors use in patients with alcoholic ketoacidosis,leading to cardiac arrest,are rare.To date,no specific treatment method for autol...BACKGROUND Case reports of symmetric digital gangrene resulting from high-dose vasopressors use in patients with alcoholic ketoacidosis,leading to cardiac arrest,are rare.To date,no specific treatment method for autolysis or surgical amputation or guidelines for determining the level of amputation have been established.CASE SUMMARY In this case report,we describe a treatment method that effectively preserved the function of fingers by surgical treatment under local anesthesia with a minimum operative time,while also preserving finger length to the maximum possible extent.CONCLUSION Our approach may contribute to improved postoperative quality of life by preserving finger length.展开更多
文摘Purpura fulminans is a hemorrhagic condition associated predominantly with meningococcal and other gram negative septicemias. It occurs mainly in infants and younger children. Features include tissue necrosis, small vessel thrombosis, disseminated intravascular coagulation, multi-organ failure and death. Other causes include clotting factor deficiencies and idiopathic varieties. The condition is uncommon due to gram positive bacterial sepsis. We report one such case with gram positive bacterial infection.
文摘An 18-year-old man had numerous multiple painful nodulocystic lesions, pustules, and necrotic hemorrhagic ulcerative lesions with crusts on the face, back, chest and upper arm two weeks ago. Systemic symptoms such as fever, general fatigue and arthralgia were not observed. Laboratory findings revealed an elevated white blood cell count with a neutrophilia and C-reactive protein. Oral antimicrobials did not respond. Consequently, oral prednisolone (20 mg/d) for two weeks induced remarkable improvement promptly. A case of acne fulminans without systemic symptoms successfully treated with oral corticosteroids has been reported.
文摘Background:Purpura fulminans(PF),characterized by the sudden onset of large,rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation,is an uncommon medical emergency.Early recognition,prompt antibiotic therapy,and intensive supportive care are essential to reduce the mortality rate of this disease.Case Presentation:We report the case of a 28-year-old Chinese man with acute infectious PF.He initially presented with a fever,which rapidly progressed to septic shock,followed by skin lesions and disseminated intravascular coagulation.Computed tomography imaging revealed superior and inferior mesenteric vein thromboses.Although the etiology of the patient’s infection was unclear,the patient received early fluid resuscitation,empiric antibiotic therapy,and blood product replacement,which resulted in gradual clinical improvement.Conclusion:Sepsis-associated PF may be reversible with timely empirical therapeutic interventions;however,the severity of PF should not be underestimated,and treatment should be tailored to individual patients.
文摘Background:Cutaneous manifestations of purpura fulminans(PF)present many challenges for clinicians and surgeons.In a state of septic shock complicated by limb ischemia,surgical interventions are necessary to control the pathological cascade and improve patient outcomes.The objective of this article was to report etiologies and surgical outcomes associated with cutaneous manifestations in adults.Methods:This systematic review and meta-analysis compared 190 adult patients with etiologies,signs and symptoms,and surgical outcomes associated with cutaneous manifestations of PF.The PubMed,EMBASE,Cochrane Library,Web of Science,and Scopus databases were systematically and independently searched.Patient and clinical characteristics,surgical interventions,outcomes,and complications were recorded.Results:Seventy-nine studies were eligible for the systematic review,and 77 were eligible for meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)and Cochrane guidelines.A total of 71/190(38%)cases reported surgical debridement.Fasciotomies were reported in 12/190(6%)cases and 20 procedures.Amputations were reported in 154/190(81%)cases.Reconstruction was reported in 45 cases.Skin grafts were applied in 31 cases.Flaps were used for reconstruction in 28 cases.Median(IQR)surgical procedures per patient were 4(4,5)procedures.Infectious organisms causing PF were 32%Neisseria meningitidis(n=55)and 32%Streptococcus pneumonia(n=55).Coagulase-negative Staphylococcus(95%confidence interval(CI)(8.2–177.9),p=0.032),Haemophilus influenza(95%CI(7.2–133),p=0.029),Streptococcus pneumonia(95%CI(13.3–75.9),p=0.006),and West Nile Virus(95%CI(8.2–177.9),p=0.032)were associated with significantly more extensive amputations compared to other organisms.Conclusion:This systematic review and patient-level meta-analysis found the most common presentation of PF was septic shock from an infectious organism.Neisseria meningitidis and Streptococcus pneumonia were equally the most common organisms associated with PF.The majority of cases were not treated in a burn center.The most common surgeries were amputations,with below-the-knee-amputations being the most common procedure.Skin grafting was the most commonly performed reconstructive procedure.The most common complications were secondary infections.Organisms with significantly more extensive amputations were coagulase-negative Staphylococcus,Haemophilus influenza,Streptococcus pneumonia,and West Nile Virus.Interpretation of findings should be cautioned due to limited sample data.
文摘BACKGROUND Case reports of symmetric digital gangrene resulting from high-dose vasopressors use in patients with alcoholic ketoacidosis,leading to cardiac arrest,are rare.To date,no specific treatment method for autolysis or surgical amputation or guidelines for determining the level of amputation have been established.CASE SUMMARY In this case report,we describe a treatment method that effectively preserved the function of fingers by surgical treatment under local anesthesia with a minimum operative time,while also preserving finger length to the maximum possible extent.CONCLUSION Our approach may contribute to improved postoperative quality of life by preserving finger length.
