Konda S, Zell D, Milikowski C, Alonso-Llamazares J
Department of Dermatology, Howard University College of Medicine, Washington, DC, USA.
Actas Dermosifiliogr. 2013 Sep;104(7):623-7. doi: 10.1016/j.adengl.2012.05.027.
Purpura fulminans is a rapidly progressive syndrome of small-vessel thrombosis and hemorrhagic necrosis of the skin accompanied by disseminated intravascular coagulation. We describe a case of Streptococcus pneumoniae septicemia in an asplenic 5-year-old boy on oral tacrolimus, with a past medical history of multivisceral organ transplantation and subsequent development of purpura fulminans on his chest and distal extremities. The acute infectious form of purpura fulminans is usually caused by gram-negative bacteria. Cases secondary to gram-positive encapsulated bacteria usually occur when individuals are immuno-suppressed or have anatomic or functional asplenia. Our patient had both, which likely increased his susceptibility, and he responded well to antimicrobial therapy in addition to prophylactic coverage in the setting of his immunosuppression. We review the literature for similar cases due to S. pneumoniae in the pediatric population and discuss the etiology and treatment of purpura fulminans.
暴发性紫癜是一种小血管血栓形成和皮肤出血性坏死并伴有弥散性血管内凝血的快速进展综合征。我们描述了一例5岁无脾男孩，因口服他克莫司，既往有多脏器移植病史，胸部及四肢远端出现暴发性紫癜，患有肺炎链球菌败血症。暴发性紫癜的急性感染形式通常由革兰氏阴性菌引起。革兰氏阳性包膜菌继发的病例通常发生在个体免疫抑制或存在解剖学或功能性无脾的情况下。我们的患者两者情况皆有，这可能增加了他的易感性，并且他除了在免疫抑制情况下进行预防性覆盖外，对抗菌治疗反应良好。我们回顾了儿科人群中因肺炎链球菌导致的类似病例的文献，并讨论了暴发性紫癜的病因和治疗。
