Purpura Fulminans in a 22-Month-Old Child: Early Recognition and Favorable Outcome Without Limb Loss

Purpura fulminans (PF) is a rare but life-threatening complication of meningococcal sepsis marked by rapidly progressive hemorrhagic skin lesions, disseminated intravascular coagulation, and microvascular thrombosis, often leading to high mortality and limb loss. We report a previously healthy 22-month-old boy who presented with fever, followed by rapidly evolving ecchymotic lesions and laboratory evidence of septic shock with disseminated intravascular coagulopathy (DIC) and markedly reduced protein C levels; blood culture and cerebrospinal fluid (CSF) polymerase chain reaction (PCR) confirmed Neisseria meningitidis. He was managed promptly with intravenous antibiotics, fluid resuscitation, vasopressors, and blood products. Therapeutic heparin was initiated as an individualized adjunct during the compensated phase of shock, although its benefit in this context remains uncertain. Early recognition and multidisciplinary intervention were associated with rapid stabilization and complete recovery without necrosis, limb loss, neurological deficits, or growth abnormalities. This case underscores the critical importance of early dermatologic recognition and aggressive management to prevent irreversible complications.