Purpura fulminans (PF) is a life-threatening condition characterised by rapidly progressive hemorrhagic infarction of the skin leading to necrosis caused by disseminated intravascular coagulation and occlusion of dermal vessels. The most common acute infection with which PF is associated is meningococcal sepsis (MS). Management includes aggressive resuscitation, volume expansion, antibiotics, inotropic and ventilatory support, correction of electrolyte and acid-base abnormalities, steroids and blood derivatives. In skin necrosis and compartment syndrome early surgical intervention is often needed. Gangrenous changes may necessitate skin grafting and/or amputations. Hyperbaric oxygen therapy (HBOT) is considered a conservative treatment option.
We present cases of two infants that have survived MS with PF.
In a five-month old boy with extensive skin lesions and gangrene of fingers and toes surgical intervention was delayed due to his poor condition. On day 10 HBOT was started and a total of 52 treatments were carried out. During the treatment MRSE superinfection was suppressed, necrotic areas became dry and delineated, most of them detached spontaneously, wounds healed and after completion of HBOT there was no need for surgical intervention.
A seven-month old boy had multiple skin necrosis and necrosis of the distal phalanges of fingers. In consultation with a surgeon, HBOT was indicated. Because of the malfunction of the hyperbaric oxygen chamber in our hospital, on the ninth day of illness the infant was transferred to the University Hospital Split where a total of 30 HBOTs were carried out. Shallow lesions healed spontaneously, but some of the deepest and the most extensive ones required debridement or skin grafting.
HBOT is a treatment in which a patient breathes 100% oxygen while inside a treatment chamber at a pressure higher than sea level. It is considered an adjunct treatment for conditions like non-healing ulcers, problem wounds and compartment syndrome. Its therapeutic effects include neovascularisation, immune stimulation, bactericidal effect and reduction of edema. In PF it may be of benefit during the phase of acute arterial ischemia, during resolution of ischemia perfusion injury and during the healing phase. In two presented cases HBOT was used to treat sequelae of PF during MS. In the first case after HBOT surgical intervention was avoided and in the second one it was required only for the more extensive lesions.
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