Case Report

Pneumococcal Purpura Fulminans Successfully Treated with Activated Protein C

Authors: Khalid M. Minhas, MD, Shahida Bashir, MD, Arif R. Sarwari, MD, John Parke,r MD


Evidence suggests that sepsis is a systemic inflammatory condition complicated by dysequilibrium in coagulation and fibrinolytic homeostasis, with a shift in the balance towards increased coagulation over fibrinolysis. Protein C is a natural anticoagulant consumed and inactivated during sepsis. We present the case of a 33-year-old female, postsplenectomy, with pneumococcal sepsis and purpura fulminans, successfully treated with activated protein C.

Key Points

* Activated protein C (APC) is approved by the Food and Drug Administration for severe sepsis with Acute Physiology And Chronic Health Evaluation (APACHE) II scores above 25. Although our patient’s APACHE II score was below 25 (18), she had clinical evidence of digit-threatening, if not life-threatening, purpura fulminans.

* A literature review indicates that patients with purpura fulminans mostly end up with amputations of their limbs. Our patient received APC with complete recovery in 12 days.

* This report suggests a role for APC in patients with purpura fulminans.

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