Potentially life-threatening emergency
Purpura fulminans in Adult
Alerts and Notices
Synopsis
In adults, purpura fulminans usually occurs in the setting of acute infection. Neisseria and varicella are the 2 most common causes, but pneumococci, measles, staphylococci, and Group A or B beta-hemolytic streptococci are also causes. Acute illness, eg, septic shock, presents 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 postinfectious 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).
Codes
ICD10CM:D65 – Disseminated intravascular coagulation [defibrination syndrome]
SNOMEDCT:
13507004 – Purpura fulminans
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- 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
- Calciphylaxis
- Acute meningococcemia
- Over-anticoagulation with heparin or warfarin
- Bleeding into hemangiomas
- Trauma
- Cocaine levamisole toxicity
- Catastrophic antiphospholipid antibody syndrome
- Vasculitis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/09/2017
Last Updated:03/23/2021
Last Updated:03/23/2021
Potentially life-threatening emergency
Purpura fulminans in Adult