Human protein C concentrate in a patient with meningitis and bleeding as a complication of treatment with recombinant activated protein C

Some case reports suggest that protein C zymogen supplementation may improve the outcome of patients with congenital or acquired protein C deficiency, such as sepsis-induced purpura fulminans. We describe the case report of a patient suf-fering from meningitis who developed a bleeding complication after recombinant human activated protein C administration and was successfully treated without any further bleeding complication with protein C concentrate.

Protein C concentrate can be considered in adult patients with meningitis, even if at risk or in the presence of bleeding.

sepsis, purpura fulmi-nans, protein C, bleeding

1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker M. Surviving sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2008;36:296-327.

2. Bernard GR, Vincent JL, Laterre PF, La Rosa SP, Lopez-Rodriguez A. The Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis. New Engl J Med 2001;344:699-709.

3. Ranieri M, Thompson TB, Barbie PS, Dhainaut JF, Douglas IS, Finfer S, et al. For the PROWESS-SHOCK Study Group. Drotrecogin Alfa (Activated) in Adults with Septic Shock. N Engl J Med 2012;366:2055-64.

4. White B, Livingstone W, Murphy C, Hodgson A, Rafferty M, Smith OP. An open-label study of the role of adjuvant hemostatic support with protein C replacement therapy in purpura fulminans-associated meningococcemia. Blood 2000;96:3719–24.

5. De Kleijn ED, De Groot R, Hack CE, H Mulder PG, Engl W, Moritz B, et al. Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: A randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med 2003;31:1839-47.

6. Baratto F, Michielan F, Meroni M, Dal Palù A, Boscolo A, Ori C. Protein C concentrate to restore physiological values in adult septic patients. Intensive Care Med 2008;34:1707-12.

7. Crivellari M, Della Valle P, Landoni G, Pappalardo F, Gerli B, Bignami E, et al. Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery. Intensive Care Med 2009;35:1959–63.

8. Dhainaut JF, Yan SB, Claessens YE. Protein C/activated protein C pathway: Overview of clinical trial results in severe sepsis. Crit Care Med 2004;32:S194-201.

9. Fisher CJ, Yan SB. Protein C levels as prognostic indicator of outcome in sepsis and related diseases. Crit Care Med 2000;28 Suppl 9:S49-56.

10. Landoni G, Crivellari M, Monti G, Gerli C, Silvani P, Zangrillo A. Human protein C concentrates in adult septic patients. Signa vitae 2008;3(2):13-7.