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A 3-year-old previously healthy boy presented with a fever (39.5°C), tonsillitis, cervical lymphadenopathy and epistaxis. Laboratory testing showed elevated C reactive protein (73 mg/L/695.2 nmol/L), leukocytosis (16 G/L), mild thrombocytopenia (138 G/L) and anaemia (haemoglobin 96 g/L). Within 24 hours, he developed gross haematuria and progressive irregular purpuric skin lesions affecting the lower extremities (figure 1), an elbow and genitals, typical of purpura fulminans. Antimicrobial therapy with third-generation cephalosporin and clindamycin was initiated. Laboratory testing for acute bacterial, fungal and viral infections was negative. Coagulation tests revealed disseminated intravascular coagulation (DIC) with …
Contributors SL: data collection, figures, writing (original draft); TD and MD: data collection, writing (review and editing); CA: data collection, literature search, writing (review and editing); JB: data collection, data analysis, writing (review and editing); JAKH: literature search, data analysis, data interpretation, writing (review and editing); JKR: data analysis, data interpretation, writing (review and editing); MK-K: literature search, figures, data analysis, data interpretation, writing (review and editing).
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.