Differential Diagnosis of Purpura Fulminans

Created on Mon, 07/13/2015 - 19:27
Last updated on Mon, 04/11/2016 - 20:53

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This has come up in Question 14.2 from the second paper of 2010.
The question ("What the hell is this?") was accompanied by an image which resembles the one below:

That is purpura fulminans, resulting - in this case - from menigococcal sepsis.

The image was stolen shamelessly from www.unboundedmedicine.com to replace the college's proprietary purpura picture.

A less florid (and therefore more common) appearance in an asplenic adult can be seen below:

Purpura fulminans in an asplenic adult

If this ever comes up again, it is likely that the college will expect the candidates to generate a list of differentials to explain this appearance.

Thus:

Causes of Purpura Fulminans

Infective

Non-infective

  • DIC from any cause
  • MAHA (microangiopathic haemolytic anaemia)
  • TTP (thrombotic thrombocytopenic purpura)
  • Vasopressor excess
  • Warfarin-induced skin necrosis
  • Congenital Protein C anticoagulant pathway defect
  • Post-infectious purpura fulminans (due to autoimmune destruction of proteins C or S)
   

 

References

Gürses, Nuran, and Ismail Ilek. "Causes of purpura fulminans." The Pediatric infectious disease journal 14.6 (1995): 552.

Spicer, Thomas E., and Jerold M. Rau. "Purpura fulminans." The American journal of medicine 61.4 (1976): 566-571.

Chalmers, E., et al. "Purpura fulminans: recognition, diagnosis and management." Archives of disease in childhood 96.11 (2011): 1066-1071.