Purpura Fulminans - Soft Tissue Damage as a Manifestation of Bacterial Sepsis

 

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Abstract

We present here two cases of purpura fulminans (PF), a rare complication of septicemia. Its fulminant course usually prompt the surgeon into quick and aggressive action. Although sometimes it may lead to mutilation of a patient, nevertheless it is a life-saving procedure. A decision to amputate all four extremities is very difficult, both for the parents and for the surgeon. Therefore one must be absolutely sure that this management strategy is the only way to save the patient's life. Two cases of meningococcal and staphylococcal sepsis treatment are described in this paper. The surgical approach is discussed together with a review of the literature.

Résumé

Ici sont présentés deux cas de Purpura Fulminans (PF), rare complication d'une septicémie. Son évolution fulminante nécessite souvent du chirurgien une action rapide et agressive. Bien que parfois il conduise à la mutilation d'un patient, c'est néanmoins un procédé de sauvetage. La décision d'amputer les quatre orteils est très difficile pour les parents et pour les chirurgiens. Néanmoins, ont doit être absolument sûr que cette stratégie est la seule pour sauver la vie du patient. Deux cas de sepsis méningococcique et staphylococcique sont décrits dans ce manuscrit. Les approches chirurgicales sont discutées avec une revue de la littérature.

Resumen

Presentamos dos casos de púrpura fulminante (PF), una rara complicación de la septicemia. El curso fulminante obliga a acciones rápidas y agresivas por parte del cirujano. Aunque a veces den lugar a mutilaciones, estos procedimientos pueden salvar la vida del paciente. La decisión de amputar las cuatro extremidades es muy difícil tanto para los padres como para el cirujano. Por lo tanto éste debe estar absolutamente seguro de que esta estrategia es la única forma de salvar la vida. Describimos dos casos de sepsis meningocócica y estafilocócica. Los métodos de tratamiento quirúrgico se discuten junto con una revisión de la literatura.

Zusammenfassung

Es werden zwei Fälle einer Purpura fulminans vorgestellt als ungewöhnliche Komplikation nach einer Sepsis. Der explosionsartige, aggressive Verlauf drängt den Chirurgen zu einer schnellen, effektiven Behandlung. Dabei muss sogar gelegentlich eine Amputation von Extremitätenanteilen in Kauf genommen werden, um das Leben des Kindes zu retten. Sogar die Amputation aller vier Extremitäten wird im Hinblick auf die Lebenserhaltung des Patienten diskutiert. Primär steht selbstverständlich eine effektive Antibiotikabehandlung im Vordergrund. In der vorliegenden Arbeit werden zwei Fälle einer Meningokokken- und Staphylokokkensepsis vorgestellt und das chirurgische und medizinische Vorgehen besprochen.

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M.D. Vidmantas Barauskas

Department of Pediatric Surgery
Kaunas Medical University Hospital

Eiveniu str. 2

Kaunas 3007

Lithuania

Email: pedsurg@kmu.lt