Background Neonatal purpura fulminans is a rare neonatal complication with high morbidity and mortality. Most case are due to protein C and/or S deficiency. Acquired causes includes sepsis.

Case B/O A was born at 35 weeks gestation, admitted with respiratory distress syndrome. He needed assisted ventilation for 5 days. At age of 10 days, he had fulminant sepsis and had deep bluish discoloration of hands, forearms, feet and legs. This discoloration progressed to dry gangrene at the tips of fingers. Investigations revealed high CRP, low platelet count, high PT and PTT, normal levels of protein C and S. Blood culture revealed acinetobacter. The neonate received the appropriate broad spectrum antibiotics along with FFP. He survived the fulminant sepsis but had auto-amputation of the distal phalanges of the hands.

Conclusion Neonatal purpura fulminans has high morbidity and mortality. It needs prompt recognition and management.