Clinico-Etiological Study of Purpura Fulminans: Experience from a Tertiary-Care Children Hospital

Background: Purpura fulminans (PF) is a potentially fatal disease characterized by rapidly progressive purpura that evolves into cutaneous necrosis and gangrene. Patients and Methods: This was an observational, retrospective study based on the review of case records of children with PF at a tertiary care children’s hospital in Karnataka. Results: Twenty-two cases seen over a period of four years were included. The age of the study population ranged from 11 days to 13 years (mean age: 4.21 years) and a male to female ratio of 1:1.2. Fever with purpura (86.3%) was the most common presenting symptom followed by swelling of the face and limbs (27.2%), altered sensorium (27.2%), convulsions (22.7%), abdominal distension (4.5%), respiratory distress (4.5%), myalgia (4.5%), and jaundice (4.5%). Cutaneous features included reticulate purpura (100%), necrosis (45.4%), ulcers (18.2%), maculopapular lesions (9.1%), and bullae (9.1%). Peripheral gangrene developed in eight children (36.3%). Lower limbs (90.9%) and upper limbs (86.3%) were the most common sites of involvement. The common causes were rickettsial fever (63.6%), Moraxella (4.5%), Leptospira (4.5%), multisystem inflammatory syndrome in children (4.5%), co-infections with Klebsiell a and Acinetobacte r (4.5%), Klebsiell a and Citrobacte r (4.5%), rickettsial fever with multisystem inflammatory syndrome (4.5%) and protein C deficiency (4.5%). The mortality rate was 4.5%. Limitations: The retrospective nature of the study and the single-institution cohort were the limitations of this study. Conclusion: Rickettsial infection was the most common etiology, while reticulate purpura, necrosis, and ulcers were the commonly seen cutaneous features of PF.