purpura fulminans


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purpura

 [per´pu-rah]
a hemorrhagic disease characterized by extravasation of blood into the tissues, under the skin, and through the mucous membranes, and producing spontaneous bruises, ecchymoses, and petechiae (small hemorrhagic spots) on the skin. (See plate in Dermatology Atlas.) When accompanied by a decrease in the circulating platelets, it is called thrombocytopenic purpura; when there is no decrease in the platelet count, it is called nonthrombocytopenic purpura. adj., adj purpu´ric.

There are two general types of thrombocytopenic purpura: primary or idiopathic, in which the cause is unknown, and secondary or symptomatic, which may be associated with exposure to drugs or other chemical agents, systemic diseases such as multiple myeloma and leukemia, diseases affecting the bone marrow or spleen, and infectious diseases such as rubella (German measles).
Symptoms. The outward manifestations and laboratory findings of primary and secondary thrombocytopenic purpura are similar. There is evidence of bleeding under the skin, with easy bruising and the development of petechiae. In the acute form there may be bleeding from any of the body orifices, such as hematuria, nosebleed, vaginal bleeding, and bleeding gums. The platelet count is below 100,000 per cubic millimeter of blood and may go as low as 10,000 per cubic millimeter (normal count is about 250,000 per cubic millimeter). The bleeding time is prolonged and clot retraction is poor. Coagulation time is normal.
Treatment. Differential diagnosis is necessary to determine the type of purpura present and to eliminate the cause if it can be determined. General measures include protection of the patient from trauma, elective surgery, and tooth extractions, any one of which may lead to severe or even fatal hemorrhage. In the thrombocytopenic form, corticosteroids may be administered when the purpura is moderately severe and of short duration. Splenectomy is indicated when other, more conservative measures fail and is successful in a majority of cases. In some instances, especially in children, there may be spontaneous and permanent recovery from idiopathic purpura. (See Atlas 2, Part Q.)
allergic purpura (anaphylactoid purpura) Henoch-Schönlein purpura.
annular telangiectatic purpura a rare form in which pinpoint reddened lesions coalesce to form a ring-shaped or continuously linked pattern, commonly beginning in the lower extremities and becoming generalized. Called also Majocchi's disease.
fibrinolytic purpura purpura associated with increased fibrinolytic activity of the blood.
purpura ful´minans a form of nonthrombocytopenic purpura seen mainly in children, usually after an infectious disease, marked by fever, shock, anemia, and sudden, rapidly spreading symmetrical skin hemorrhages of the lower limbs, often associated with extensive intravascular thromboses and gangrene.
purpura hemorrha´gica primary thrombocytopenic purpura.
Henoch's purpura a type of Henoch-Schönlein purpura in which abdominal symptoms predominate.
Henoch-Schönlein purpura a type of nonthrombocytopenic purpura, of unknown cause but thought to be due to a vasculitis; it is most often seen in children and is associated with clinical symptoms such as urticaria and erythema, arthritis and other joint diseases, gastrointestinal symptoms, and renal involvement. Called also Schönlein-Henoch purpura or syndrome and allergic or anaphylactoid purpura.
idiopathic thrombocytopenic purpura thrombocytopenic purpura not directly associated with any definable systemic disease, although it often follows a systemic infection; the cause is thought to be an IgG immunoglobulin that acts as an antibody against platelets, causing ecchymoses, petechiae, and other bleeding. There are both acute and chronic forms: the acute form has a sudden onset, is more common in children, and usually resolves spontaneously within a few months; the chronic form has a slower onset, is more common in adults, and may be recurrent.
nonthrombocytopenic purpura purpura without any decrease in the platelet count of the blood. In such cases the cause is either abnormal capillary fragility or a clotting factor deficiency.
Schönlein purpura a type of Henoch-Schönlein purpura in which articular systems predominate; called also Schönlein's disease.
Schönlein-Henoch purpura Henoch-Schönlein purpura.
purpura seni´lis dark purplish red ecchymoses occurring on the forearms and backs of the hands in the elderly.
thrombocytopenic purpura purpura associated with a decrease in the number of platelets in the blood; see purpura.
thrombotic thrombocytopenic purpura a form of thrombotic microangiopathy characterized by thrombocytopenia, hemolytic anemia, bizarre neurological manifestations, uremia (azotemia), fever, and thromboses in terminal arterioles and capillaries; some authorities consider it identical to the hemolytic uremic syndrome. Called also microangiopathic hemolytic anemia and Moschcowitz's disease.

pur·pu·ra ful·'mi·nans

a severe and rapidly fatal form of purpura hemorrhagica, occurring especially in children, with hypotension, fever, and disseminated intravascular coagulation, usually following an infectious illness.

purpura fulminans

A life-threatening condition of acute onset occurring in infants, which is characterised by cutaneous haemorrhage and necrosis, hypotension, fever and disseminated intravascular coagulation (DIC), caused by sepsis or severe bacterial infection, most commonly by meningococci and gram-negative rods, often in a background of protein-C or protein-S deficiency.

Management
Remove cause, antibiotic coverage, fluid support, amputation if necessary.

pur·pu·ra ful·mi·nans

(pŭr'pyŭr-ă ful'mi-nanz)
A severe and rapidly fatal form of purpura hemorrhagica, occurring especially in children, with hypotension, fever, and disseminated intravascular coagulation, usually following an infectious illness.
References in classic literature ?
Heyward felt a burning desire to rush forward to meet them, so intense was the delirious anxiety of the moment; but he was restrained by the deliberate examples of the scout and Uncas.
Nobody ought to know it IS me standing by the river; it ought to be `Rebecca,' or `the darker maiden;' and `the rush to Emma Jane' is simply dreadful.
He made a wild rush forward--slipt on the steps in some sticky, acrid-smelling mass that felt and smelt like blood, and, falling forward, felt his way into the inner room, where the well-shaft was not.
But they were gallantly rallied by their old chief and came on with such a rush that the ape-men began in turn to give way.
With the summer rush from the Outside came special correspondents for the big newspapers and magazines, and one and all, using unlimited space, they wrote Daylight up; so that, so far as the world was concerned, Daylight loomed the largest figure in Alaska.
He was confused and blinded by the rush of it and the beat of angry wings.
Sir Nigel was thrown down by the sheer weight of them, and Sir Bertrand with his thunderous war-cry was swinging round his heavy sword to clear a space for him to rise, when the whistle of two long English arrows, and the rush of the squire and the two English archers down the stairs, turned the tide of the combat.
As it is when a rock shoots out from a great cliff and whirls down with long bounds, careering eagerly with a roar, and a high crag clashes with it and keeps it there where they strike together; with no less clamour did deadly Ares, the chariot- borne, rush shouting at Heracles.
it has broken; the ball is driven out on the School- house side, and a rush of the School carries it past the School- house players-up.
As Buck drew himself together to spring after them, out of the tail of his eye he saw Spitz rush upon him with the evident intention of overthrowing him.
Saxon could not see the cause of all this, but she could guess when she saw the larger boys rush to the gutter, pick up stones, and sneak into the alleys between the houses.
It seemed to explode all round the ship with an overpowering concussion and a rush of great waters, as if an immense dam had been blown up to windward.