Purpura fulminans in Adult
In adults, purpura fulminans usually occurs in the setting of acute infection. Neisseria and varicella are the two most common causes, but pneumococci, measles, staphylococci, and Group A or B beta-hemolytic streptococci are also causes. Acute illness presents as a septic-appearing patient with high fever and rapid deterioration, leading to hypotension and end-organ dysfunction. There is often progression from initial acral purpura to widespread ecchymoses and gangrene.
Asplenia is also a risk factor for acute purpura fulminans.
Purpura fulminans can also occur in a post-infectious form 7-10 days following a bacterial or viral illness, and is thought to be due to temporary decreases in proteins C and S or antithrombin III (such as from antibodies triggered by infection that interfere with protein S).
D65 – Disseminated intravascular coagulation [defibrination syndrome]
13507004 – Purpura fulminans
- Coumadin necrosis (warfarin necrosis) – Purpura from warfarin is more prominent on fatty areas such as the breasts, buttocks, and thighs, while purpura fulminans is usually more extensive.
- Necrotizing fasciitis
- Rocky Mountain spotted fever
- Toxic shock syndrome
- Thrombotic thrombocytopenic purpura
- Acute meningococcemia
- Over-anticoagulation with heparin or warfarin
- Bleeding into hemangiomas
- Cocaine levamisole toxicity
- Catastrophic antiphospholipid antibody syndrome
Last Updated: 05/30/2017